Healthcare Provider Details

I. General information

NPI: 1083644561
Provider Name (Legal Business Name): SKAGGS COMMUNITY HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 12/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 BRANSON LANDING BLVD SUITE 504
BRANSON MO
65616
US

IV. Provider business mailing address

545 BRANSON LANDING BLVD SUITE 504
BRANSON MO
65616
US

V. Phone/Fax

Practice location:
  • Phone: 417-335-7540
  • Fax: 417-335-7544
Mailing address:
  • Phone: 417-335-7540
  • Fax: 417-335-7544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number52-53
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number52-53
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number52-53
License Number StateMO

VIII. Authorized Official

Name: WILLIAM K MAHONEY
Title or Position: CEO
Credential:
Phone: 417-335-7270