Organization
LESTER E. COX MEDICAL CENTERS
Active
Other names
PEDIATRIC HOSPITAL AFFILIATES
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID P TAYLOR (VICE PRESIDENT)
(417) 269-6262
Entity
Organization
Contact information
Practice address
1423 N JEFFERSON AVE, SPRINGFIELD, MO 65802-1917
(417) 269-5711
(417) 269-4869
Mailing address
3800 S NATIONAL AVE, #540, SPRINGFIELD, MO 65807-5209
(417) 269-6262
(417) 269-4349
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
507465607
—
MO
01
—
95323
BLUE CROSS OF MO
—
Enumeration date
10/19/2006
Last updated
06/20/2008
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