Provider Demographics
NPI:1619208303
Name:SKAGGS-COX HEALTH ALLIANCE, LLC.
Entity Type:Organization
Organization Name:SKAGGS-COX HEALTH ALLIANCE, LLC.
Other - Org Name:THE CLINIC AT WAL-MART OPERATED BY COX HEALTH IN PARTNERSHIP WITH SKAG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:H
Authorized Official - Last Name:BEZANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-269-3108
Mailing Address - Street 1:PO BOX 4046
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65808-4046
Mailing Address - Country:US
Mailing Address - Phone:417-269-5712
Mailing Address - Fax:417-269-4869
Practice Address - Street 1:1101 BRANSON HILLS PKWY
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-9942
Practice Address - Country:US
Practice Address - Phone:417-336-0536
Practice Address - Fax:417-336-0539
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COX HEALTH ALLIANCE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-01-20
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty