Provider Demographics
NPI:1295733103
Name:INSTITUTE FOR BEAUTY AND WOMEN'S HEALTH LLC
Entity type:Organization
Organization Name:INSTITUTE FOR BEAUTY AND WOMEN'S HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:P
Authorized Official - Last Name:NERMARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD OBGYN
Authorized Official - Phone:417-335-2080
Mailing Address - Street 1:590 W PACIFIC
Mailing Address - Street 2:
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616
Mailing Address - Country:US
Mailing Address - Phone:417-335-2080
Mailing Address - Fax:417-336-3583
Practice Address - Street 1:590 W PACIFIC
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616
Practice Address - Country:US
Practice Address - Phone:417-335-2080
Practice Address - Fax:417-335-2080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 1041C0700X
MO35042207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1891962312Medicaid
MO506013903Medicaid
MO596013904Medicaid
MO506013903Medicaid
MO263959Medicare Oscar/Certification
MO000013798Medicare PIN