Provider Demographics
NPI: | 1922126077 |
---|---|
Name: | LESTER E COX MEDICAL CENTERS |
Entity Type: | Organization |
Organization Name: | LESTER E COX MEDICAL CENTERS |
Other - Org Name: | COX MEDICAL CENTERS |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | EXEC. VICE-PRESIDENT & CFO |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | JACOB |
Authorized Official - Middle Name: | M |
Authorized Official - Last Name: | MCWAY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 417-269-8811 |
Mailing Address - Street 1: | 1423 N JEFFERSON AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | SPRINGFIELD |
Mailing Address - State: | MO |
Mailing Address - Zip Code: | 65802-1917 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 417-269-3000 |
Mailing Address - Fax: | 417-269-3104 |
Practice Address - Street 1: | 3801 S NATIONAL AVE |
Practice Address - Street 2: | |
Practice Address - City: | SPRINGFIELD |
Practice Address - State: | MO |
Practice Address - Zip Code: | 65807-5210 |
Practice Address - Country: | US |
Practice Address - Phone: | 417-269-6000 |
Practice Address - Fax: | 417-269-3104 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-03-27 |
Last Update Date: | 2023-08-18 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | Group - Multi-Specialty | |
No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
No | 133V00000X | Dietary & Nutritional Service Providers | Dietitian, Registered | Group - Multi-Specialty | |
No | 207P00000X | Allopathic & Osteopathic Physicians | Emergency Medicine | Group - Multi-Specialty | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
No | 207RI0011X | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | Group - Multi-Specialty |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
No | 2080P0202X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Cardiology | Group - Multi-Specialty |
No | 2085R0001X | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | Group - Multi-Specialty |
No | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | Group - Multi-Specialty |
No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty | |
No | 261QU0200X | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MO | 540419603 | Medicaid | |
124287 | Other | BLUE CROSS | |
MO | 540419603 | Medicaid |