Provider Demographics
NPI:1013241363
Name:SKAGGS COMMUNITY HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:SKAGGS COMMUNITY HOSPITAL ASSOCIATION
Other - Org Name:SKAGGS SOUTH POINTE MEDICAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:R
Authorized Official - Last Name:MARCELLUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:417-335-7217
Mailing Address - Street 1:2461 STATE HIGHWAY 165
Mailing Address - Street 2:SUITE E
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-8690
Mailing Address - Country:US
Mailing Address - Phone:417-348-8964
Mailing Address - Fax:417-336-0275
Practice Address - Street 1:2461 STATE HIGHWAY 165
Practice Address - Street 2:SUITE E
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-8690
Practice Address - Country:US
Practice Address - Phone:417-348-8964
Practice Address - Fax:417-336-0275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-18
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000160620207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty