Provider Demographics
NPI:1164456612
Name:LESTER E. COX MEDICAL CENTERS
Entity Type:Organization
Organization Name:LESTER E. COX MEDICAL CENTERS
Other - Org Name:COXHEALTH CENTER ROGERSVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VP & CFO
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:MCWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-269-8811
Mailing Address - Street 1:PO BOX 505673
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-5673
Mailing Address - Country:US
Mailing Address - Phone:417-730-6430
Mailing Address - Fax:417-269-7567
Practice Address - Street 1:151 JOHNSTOWN DRIVE
Practice Address - Street 2:
Practice Address - City:ROGERSVILLE
Practice Address - State:MO
Practice Address - Zip Code:65742-9366
Practice Address - Country:US
Practice Address - Phone:417-269-2252
Practice Address - Fax:417-269-2259
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LESTER E. COX MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO596059006Medicaid
MO596059006Medicaid
MO596059006Medicaid
268564Medicare Oscar/Certification
990001480Medicare PIN