Organization
LESTER E COX MEDICAL CENTERS
Active
Other names
Regional Services, Northside Pediatrics & Adolescents
Organization subpart
No
Provider details
NPI number
Authorized official
BROCK SHAMEL (VICE PRESIDENT)
(417) 269-4368
Entity
Organization
Contact information
Practice address
1443 N ROBBERSON AVE, SUITE 200, SPRINGFIELD, MO 65802-1928
(417) 269-8061
(417) 269-8087
Mailing address
PO BOX 7411626, CHICAGO, IL 60674-5626
(417) 730-6430
(417) 269-7567
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500458500
—
MO
Enumeration date
11/27/2006
Last updated
06/18/2025
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