Provider Demographics
NPI:1841313475
Name:BRANSON ONCOLOGY CLINIC, L.L.C.
Entity type:Organization
Organization Name:BRANSON ONCOLOGY CLINIC, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER OF BRANSON ONCOLOGY CLINI
Authorized Official - Prefix:DR
Authorized Official - First Name:PAIROTE
Authorized Official - Middle Name:
Authorized Official - Last Name:JAROONWANICHKUL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:417-339-5500
Mailing Address - Street 1:545 BRANSON LANDING BLVD.
Mailing Address - Street 2:SUITE 404
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616
Mailing Address - Country:US
Mailing Address - Phone:417-339-5500
Mailing Address - Fax:417-339-5505
Practice Address - Street 1:545 BRANSON LANDING BOULEVARD.
Practice Address - Street 2:SUITE 404
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616
Practice Address - Country:US
Practice Address - Phone:417-339-5500
Practice Address - Fax:417-339-5505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO102149174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOF46302Medicare UPIN