Healthcare Provider Details

I. General information

NPI: 1366042442
Provider Name (Legal Business Name): LESTER E COX MEDICAL CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2020
Last Update Date: 10/28/2020
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 REDWOOD DR
NEW BLOOMFIELD MO
65063-5417
US

IV. Provider business mailing address

PO BOX 802843
KANSAS CITY MO
64180-2208
US

V. Phone/Fax

Practice location:
  • Phone: 573-491-3700
  • Fax:
Mailing address:
  • Phone: 417-269-5712
  • Fax: 417-269-7567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MAX DAVIS BUETOW
Title or Position: VICE PRESIDENT
Credential:
Phone: 417-631-0381