Provider Demographics
NPI:1245250091
Name:NEW MEDICO HEALTHCARE CORPORATION
Entity type:Organization
Organization Name:NEW MEDICO HEALTHCARE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDILBERTO
Authorized Official - Middle Name:B
Authorized Official - Last Name:LORENZO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:417-777-1182
Mailing Address - Street 1:PO BOX 209
Mailing Address - Street 2:
Mailing Address - City:OSAGE BEACH
Mailing Address - State:MO
Mailing Address - Zip Code:65065-0209
Mailing Address - Country:US
Mailing Address - Phone:417-777-1182
Mailing Address - Fax:417-777-1183
Practice Address - Street 1:3361 S SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613-9132
Practice Address - Country:US
Practice Address - Phone:417-777-1182
Practice Address - Fax:417-777-1183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002181101YP2500X
MO200100005201041C0700X
KS04-154752084P0800X
ARR45662084P0805X
TN00000294422084P0805X
MO332942084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR128988002Medicaid
MO493986483Medicaid
MO498904515Medicaid
MO505355909Medicaid
AR127191001Medicaid
MO208100107Medicaid
MO208100107Medicaid
MO505355909Medicaid
AR127191001Medicaid
MOE58805Medicare UPIN
TNP00259222Medicare ID - Type UnspecifiedRAILROAD GROUP PROVIDER
TNDD9038Medicare ID - Type UnspecifiedMEDICARE RAILROAD GROUP
AR128988002Medicaid
MO001012450Medicare ID - Type UnspecifiedMO GROUP PROVIDER
MO823122450Medicare PIN