Organization
LESTER E. COX MEDICAL CENTERS
Active
Other names
NORTHSIDE PEDIATRICS & ADOLESCENTS
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID P TAYLOR (VICE PRESIDENT)
(417) 269-6262
Entity
Organization
Contact information
Practice address
1443 N ROBBERSON AVE, SUITE 200, SPRINGFIELD, MO 65802-1928
(417) 269-8061
(417) 269-8087
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
01
—
1483
BLUE CROSS OF MO
—
05
—
500458500
—
MO
Enumeration date
10/13/2006
Last updated
06/20/2008
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