Healthcare Provider Details

I. General information

NPI: 1336566793
Provider Name (Legal Business Name): REX MCGEE BC-HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2014
Last Update Date: 03/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3829 S CAMPBELL AVE
SPRINGFIELD MO
65807-5339
US

IV. Provider business mailing address

3829 S CAMPBELL AVE
SPRINGFIELD MO
65807-5339
US

V. Phone/Fax

Practice location:
  • Phone: 417-883-1616
  • Fax: 417-883-1644
Mailing address:
  • Phone: 417-883-1616
  • Fax: 417-883-1644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA001254
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: