Provider Demographics
NPI:1073751442
Name:LESTER E COX MEDICAL CENTERS
Entity Type:Organization
Organization Name:LESTER E COX MEDICAL CENTERS
Other - Org Name:THE CLINIC AT WALMART OPERATED BY COXHEALTH STORE # 1009
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BROCK
Authorized Official - Middle Name:P
Authorized Official - Last Name:SHAMEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-269-4368
Mailing Address - Street 1:PO BOX 802843
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-2843
Mailing Address - Country:US
Mailing Address - Phone:417-730-6430
Mailing Address - Fax:417-269-7567
Practice Address - Street 1:1150 US HIGHWAY 60 E
Practice Address - Street 2:
Practice Address - City:REPUBLIC
Practice Address - State:MO
Practice Address - Zip Code:65738-1580
Practice Address - Country:US
Practice Address - Phone:417-269-4420
Practice Address - Fax:417-269-9434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-23
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty