MEDICARE: REGIONAL SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1639711369
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGIONAL SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 4046
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65808-4046
Country	:	US
Telephone Number	:	417-269-5712
Fax Number	:	417-269-7567

Provider Business Practice Location Address
First Line	:	54 MEDICAL SPRINGS RD
Second Line	:
City	:	GALENA
State	:	MO
Zip	:	65656-8386
Country	:	US
Telephone Number	:	417-357-6377
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MAX BUETOW
Credential	:
Telephone Number	:	417-631-0381

Provider Enumeration Date	:	10/15/2019
Last Update Date	:	01/30/2020

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Directions to “REGIONAL SERVICES ” Practice Location

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