Provider Demographics
NPI:1932210077
Name:MED-TECH OF BRANSON LLC
Entity Type:Organization
Organization Name:MED-TECH OF BRANSON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:ROCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-252-8164
Mailing Address - Street 1:1206 N HIGHWAY 81
Mailing Address - Street 2:SUITE 61
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-1729
Mailing Address - Country:US
Mailing Address - Phone:580-252-8164
Mailing Address - Fax:580-255-1516
Practice Address - Street 1:2001 HWY 248
Practice Address - Street 2:SUITE 5
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-3407
Practice Address - Country:US
Practice Address - Phone:417-334-4272
Practice Address - Fax:417-334-5272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO743126473332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO196461OtherBLUE CROSS BLUE SHIELD
MO626176606Medicaid
MO196461OtherBLUE CROSS BLUE SHIELD