Healthcare Provider Details

I. General information

NPI: 1245186303
Provider Name (Legal Business Name): STILL WATERS MEDICAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2026
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 W 76 COUNTRY BLVD STE 16924985
BRANSON MO
65616-2170
US

IV. Provider business mailing address

2800 W 76 COUNTRY BLVD STE 16924985
BRANSON MO
65616-2170
US

V. Phone/Fax

Practice location:
  • Phone: 855-400-3575
  • Fax:
Mailing address:
  • Phone: 417-386-0932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. OKWUCHI OGBONNA
Title or Position: MANAGING MEMBER
Credential:
Phone: 855-400-3575