Provider Demographics
NPI:1144256462
Name:LESTER E COX MEDICAL CENTERS
Entity type:Organization
Organization Name:LESTER E COX MEDICAL CENTERS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR. VICE-PRESIDENT & CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MAX
Authorized Official - Middle Name:
Authorized Official - Last Name:BUETOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-631-0381
Mailing Address - Street 1:3800 S NATIONAL AVE
Mailing Address - Street 2:STE. 540
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-5209
Mailing Address - Country:US
Mailing Address - Phone:417-269-5712
Mailing Address - Fax:417-269-7567
Practice Address - Street 1:106 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:MO
Practice Address - Zip Code:65605-6260
Practice Address - Country:US
Practice Address - Phone:417-269-2400
Practice Address - Fax:417-269-2410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2017-03-14
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
MO505690800Medicaid
189999OtherBLUE CROSS
MO596053405Medicaid
189999OtherBLUE CROSS
MO505690800Medicaid
268565Medicare Oscar/Certification
DA0935Medicare PIN