Provider Demographics
NPI:1801190459
Name:SKAGGS COMMUNITY HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:SKAGGS COMMUNITY HOSPITAL ASSOCIATION
Other - Org Name:SKAGGS PLASTIC & RECONSTRUCTIVE SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL STAFF SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:L
Authorized Official - Last Name:PENNETTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-335-7490
Mailing Address - Street 1:121 CAHILL RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-2036
Mailing Address - Country:US
Mailing Address - Phone:417-334-8253
Mailing Address - Fax:417-337-8992
Practice Address - Street 1:121 CAHILL RD
Practice Address - Street 2:SUITE 205
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-2036
Practice Address - Country:US
Practice Address - Phone:417-334-8253
Practice Address - Fax:417-337-8992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-22
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO52-53208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty