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18452 Business Hwy 13 Branson West MO 65737 | |
(417) 272-8911 | |
(417) 272-3900 |
Full Name | |
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Speciality | Clinic/Center |
Location | 18452 Business Hwy 13, Branson West, Missouri |
Authorized Official Name and Position | Daniel Roth (VP OF OPERATIONS) |
Authorized Official Contact | 4172693104 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 505673 Saint Louis MO 63150-5673 Ph: (417) 730-6430 | 18452 Business Hwy 13 Branson West MO 65737 Ph: (417) 272-8911 |
NPI Number | 1366520694 |
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Provider Enumeration Date | 11/02/2006 |
Last Update Date | 09/30/2024 |
Medicare PECOS PAC ID | 5092624320 |
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Medicare Enrollment ID | O20030314000004 |
Identifier | Type | State | Issuer |
---|---|---|---|
1366520694 | NPI | - | NPPES |
598473700 | Medicaid | MO | |
507231801 | Medicaid | MO |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Lakeland Clinical Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 18565 Business 13, Branson West, MO 65737 Phone: 417-272-8064 Fax: 417-272-0073 | |
White Oak Medical, Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 11016 State Highway 76, Claybough Plaza, Ste 6, Branson West, MO 65737 Phone: 417-272-0505 Fax: 417-272-3020 | |