DR. JACK LEON GREGSTON MD NPI 1225177447

NPI Information

NPI: 1225177447
Provider Name: DR. JACK LEON GREGSTON, MD
Classification: Radiology - 2085R0202X
Entity Type: Individual

Specialization: Diagnostic Radiology

PECOS Registration: Yes

Address:
1235 E CHEROKEE ST
SPRINGFIELD, MO
ZIP 65804
Phone: (417) 820-2500
Get Directions

DR. Jack Leon Gregston, MD is a diagnostic radiology radiology in Springfield, MO. The provider is a radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. DR. Jack Leon Gregston, MD NPI is 1225177447. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

1235 E CHEROKEE ST
SPRINGFIELD, MO
ZIP 65804-203
Phone: (417) 820-2500
Fax: (417) 820-8155

The NPI 1225177447 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 2/5/2007 and was last updated on 4/27/2009.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2085R0202X	Radiology	Diagnostic Radiology	104377	MISSOURI	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	81773	OTHER	ARKANSAS	AR BLUE SHIELD
2	080013268	MEDICARE PIN	MISSOURI
3	134038001	MEDICAID	ARKANSAS
4	206769218	MEDICAID	MISSOURI
5	173098	OTHER	MISSOURI	MO BLUE SHIELD
6	C94989	OTHER		UPIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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