Provider Demographics
NPI:1588659411
Name:TRI-LAKES SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:TRI-LAKES SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:V
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:417-335-8572
Mailing Address - Street 1:915 HIGHWAY 248
Mailing Address - Street 2:SUITE B
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-8154
Mailing Address - Country:US
Mailing Address - Phone:417-335-8572
Mailing Address - Fax:417-335-8573
Practice Address - Street 1:915 HIGHWAY 248
Practice Address - Street 2:SUITE B
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-8154
Practice Address - Country:US
Practice Address - Phone:417-335-8572
Practice Address - Fax:417-335-8573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO168-0261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical