Provider Demographics
NPI:1881678688
Name:SKAGGS COMMUNITY HEALTH CENTER AND CLINICS
Entity Type:Organization
Organization Name:SKAGGS COMMUNITY HEALTH CENTER AND CLINICS
Other - Org Name:BRANSON HEART CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:ERIXSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-336-4112
Mailing Address - Street 1:1150 STATE HIGHWAY 248
Mailing Address - Street 2:STE. 100
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-3758
Mailing Address - Country:US
Mailing Address - Phone:417-336-4112
Mailing Address - Fax:417-335-4684
Practice Address - Street 1:1150 STATE HIGHWAY 248
Practice Address - Street 2:STE. 100
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-3758
Practice Address - Country:US
Practice Address - Phone:417-336-4112
Practice Address - Fax:417-335-4684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-05
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR155784002Medicaid
MOCI2096OtherRAILROAD MEDICARE
MO507263200Medicaid
MO000014479Medicare PIN
MOCI2096OtherRAILROAD MEDICARE