Basic Information
| Provider Information | |||||||||
| NPI: | 1942201678 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RICHARDSON | ||||||||
| FirstName: | LESTER | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 411039 | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641411039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9132341350 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 12300 METCALF AVE | ||||||||
| Address2: | |||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662131324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9133177485 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2005 | ||||||||
| LastUpdateDate: | 07/14/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 05-21420 | KS | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 100231530C | 05 | KS | MEDICAID | 100231530A | 05 | KS | MEDICAID | 12598099 | 01 | KS | BCBS OF KC MO | OTHER | 246039101 | 05 | MO | MEDICAID | 01674018 | 01 | BCBS KC MO GROUP 0167401 | OTHER | 12598119 | 01 | MO | BCBS OF KC MO | OTHER | 930036542 | 01 | RR MEDICARE GROUP CG8899 | OTHER | P00215045 | 01 | RR MEDICARE GROUP DC6712 | OTHER |