MEDICARE: SKAGGS COMMUNITY HOSPITAL ASSOCIATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CI2096	OTHER		RAILROAD MEDICARE

General Provider Information

NPI Number	:	1023167236
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SKAGGS COMMUNITY HOSPITAL ASSOCIATION

Provider Business Mailing Address
First Line	:	PO BOX 770
Second Line	:
City	:	BRANSON
State	:	MO
Zip	:	65615-0770
Country	:	US
Telephone Number	:	417-336-5100
Fax Number	:	417-336-5107

Provider Business Practice Location Address
First Line	:	895 STATE HIGHWAY 248
Second Line	:
City	:	BRANSON
State	:	MO
Zip	:	65616-3721
Country	:	US
Telephone Number	:	417-336-5100
Fax Number	:	417-336-5107

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MR. WILLIAM K MAHONEY
Credential	:
Telephone Number	:	417-335-7270

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	03/25/2010

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Directions to “SKAGGS COMMUNITY HOSPITAL ASSOCIATION ” Practice Location

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