Provider Demographics
NPI:1902854037
Name:BOTHWELL REGIONAL HEALTH CENTER
Entity Type:Organization
Organization Name:BOTHWELL REGIONAL HEALTH CENTER
Other - Org Name:BOTHWELL OB/GYN ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:660-829-7790
Mailing Address - Street 1:PO BOX 801128
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-1128
Mailing Address - Country:US
Mailing Address - Phone:660-827-0015
Mailing Address - Fax:660-827-7425
Practice Address - Street 1:3700 W 10TH ST STE 100
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-2540
Practice Address - Country:US
Practice Address - Phone:660-827-0015
Practice Address - Fax:660-827-7425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO37038013OtherBLUE CROSS BLUE SHIELD
MOCK7172OtherPALMETTO GBA
MO590113783Medicaid
MO7260000DMedicare ID - Type Unspecified