| |
1601 Branson Hills Pkwy Ste 100 Branson MO 65616-9908 | |
(417) 348-8964 | |
(417) 336-0275 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1601 Branson Hills Pkwy Ste 100, Branson, Missouri |
Authorized Official Name and Position | William K Mahoney (CHIEF EXECXUTIVE OFFICER) |
Authorized Official Contact | 4173357270 |
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 | 1601 Branson Hills Pkwy Ste 100 Branson MO 65616-9908 Ph: (417) 348-8964 |
NPI Number | 1629156971 |
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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 | O20080229000186 |
Identifier | Type | State | Issuer |
---|---|---|---|
1629156971 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Drs Family Medical Clinic, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 118 N 3rd St, Branson, MO 65616 Phone: 417-334-3655 Fax: 417-334-3614 | |