Provider Demographics
NPI:1518040443
Name:HEALING ARTS CENTER L.L.C.
Entity Type:Organization
Organization Name:HEALING ARTS CENTER L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-334-6660
Mailing Address - Street 1:225 VIOLYN DR
Mailing Address - Street 2:
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-8128
Mailing Address - Country:US
Mailing Address - Phone:417-334-6660
Mailing Address - Fax:417-334-6661
Practice Address - Street 1:225 VIOLYN DR
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-8128
Practice Address - Country:US
Practice Address - Phone:417-334-6660
Practice Address - Fax:417-334-6661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006810111N00000X
MO2003012564111N00000X
261QM1300X, 261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO503736209Medicaid
MO199107OtherBCBS FACILITY NUMBER
MO199107OtherBCBS FACILITY NUMBER