Provider Demographics
NPI:1508057712
Name:WOMANS CLINIC OF BRANSON, LLC
Entity Type:Organization
Organization Name:WOMANS CLINIC OF BRANSON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:P
Authorized Official - Last Name:KRATZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:417-887-5500
Mailing Address - Street 1:1135 E LAKEWOOD SUITE 112
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65810
Mailing Address - Country:US
Mailing Address - Phone:417-334-7275
Mailing Address - Fax:417-883-8964
Practice Address - Street 1:5571 N GRETNA RD
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-7287
Practice Address - Country:US
Practice Address - Phone:417-334-7275
Practice Address - Fax:417-883-8964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMD101532207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOF33898Medicare UPIN