Organization
NEW MEDICO HEALTHCARE CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDILBERTO B LORENZO MD (OWNER)
(417) 777-1182
Entity
Organization
Contact information
Practice address
3361 S SPRINGFIELD AVE, BOLIVAR, MO 65613-9132
(417) 777-1182
(417) 777-1183
Mailing address
PO BOX 209, OSAGE BEACH, MO 65065-0209
(417) 777-1182
(417) 777-1183
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
002181
MO
1041C0700X
Clinical Social Worker
20010000520
MO
2084P0800X
Psychiatry Physician
04-15475
KS
2084P0800X
Psychiatry Physician
Primary
33294
MO
2084P0805X
Geriatric Psychiatry Physician
0000029442
TN
2084P0805X
Geriatric Psychiatry Physician
R4566
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
127191001
—
AR
05
—
128988002
—
AR
05
—
208100107
—
MO
05
—
493986483
—
MO
05
—
498904515
—
MO
05
—
505355909
—
MO
Enumeration date
07/21/2006
Last updated
09/25/2014
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