=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144256462
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LESTER E COX MEDICAL CENTERS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2006
-----------------------------------------------------
Last Update Date | 03/14/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 106 COMMERCE DR
-----------------------------------------------------
City | AURORA
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65605-6260
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-269-2400
-----------------------------------------------------
Fax | 417-269-2410
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3800 S NATIONAL AVE STE. 540
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65807-5209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-269-5712
-----------------------------------------------------
Fax | 417-269-7567
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SR. VICE-PRESIDENT & CFO
-----------------------------------------------------
Name | MR. MAX BUETOW
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 417-631-0381
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------