Healthcare Provider Details

I. General information

NPI: 1245250091
Provider Name (Legal Business Name): NEW MEDICO HEALTHCARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 09/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3361 S SPRINGFIELD AVE
BOLIVAR MO
65613-9132
US

IV. Provider business mailing address

PO BOX 209
OSAGE BEACH MO
65065-0209
US

V. Phone/Fax

Practice location:
  • Phone: 417-777-1182
  • Fax: 417-777-1183
Mailing address:
  • Phone: 417-777-1182
  • Fax: 417-777-1183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number002181
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number20010000520
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number04-15475
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberR4566
License Number StateAR
# 5
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number0000029442
License Number StateTN
# 6
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number33294
License Number StateMO

VIII. Authorized Official

Name: DR. EDILBERTO B LORENZO
Title or Position: OWNER
Credential: MD
Phone: 417-777-1182