Provider Demographics
NPI:1659402436
Name:SKAGGS COMMUNITY HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:SKAGGS COMMUNITY HOSPITAL ASSOCIATION
Other - Org Name:SKAGGS MEDICAL SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ERIXON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-335-7000
Mailing Address - Street 1:PO BOX 879342
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64187-9342
Mailing Address - Country:US
Mailing Address - Phone:417-348-8611
Mailing Address - Fax:
Practice Address - Street 1:4480 N GRETNA RD
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-7202
Practice Address - Country:US
Practice Address - Phone:417-334-2114
Practice Address - Fax:417-335-7588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
87726OtherUNITED HEALTH CARE
MO620932509Medicaid
87726OtherUNITED HEALTH CARE