Provider Demographics
NPI:1902034218
Name:OZARK MOUNTAIN EAR NOSE & THROAT
Entity Type:Organization
Organization Name:OZARK MOUNTAIN EAR NOSE & THROAT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER OF LLC
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:TRAVIS
Authorized Official - Last Name:BRAWNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:417-230-7874
Mailing Address - Street 1:545 BRANSON LANDING BLVD
Mailing Address - Street 2:SUITE 410
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-4500
Mailing Address - Country:US
Mailing Address - Phone:405-209-8169
Mailing Address - Fax:
Practice Address - Street 1:186 S PAYNE STEWART DR STE 201
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-2732
Practice Address - Country:US
Practice Address - Phone:417-335-3636
Practice Address - Fax:417-335-3626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-24
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009001424207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty