Healthcare Provider Details

I. General information

NPI: 1982489076
Provider Name (Legal Business Name): LESTER E. COX MEDICAL CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2023
Last Update Date: 08/28/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E PRIMROSE ST SUITE 105A
SPRINGFIELD MO
65807
US

IV. Provider business mailing address

1000 E PRIMROSE ST SUITE 105A
SPRINGFIELD MO
65807
US

V. Phone/Fax

Practice location:
  • Phone: 417-269-5584
  • Fax: 417-269-5582
Mailing address:
  • Phone: 417-269-5584
  • Fax: 417-269-5582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JACOB MCWAY
Title or Position: CFO
Credential:
Phone: 417-269-8811