Healthcare Provider Details

I. General information

NPI: 1548359037
Provider Name (Legal Business Name): SURGERY CENTER OF BRANSON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 JAMES F EPPS RD
BRANSON MO
65616-7347
US

IV. Provider business mailing address

1531 EAST BRADFORD PARKWAY STE 100
SPRINGFIELD MO
65804-6539
US

V. Phone/Fax

Practice location:
  • Phone: 417-334-9689
  • Fax: 417-334-5765
Mailing address:
  • Phone: 417-887-3900
  • Fax: 417-823-2894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberPENDING
License Number StateMO

VIII. Authorized Official

Name: LISA SMITH
Title or Position: ASC DIRECTOR
Credential:
Phone: 417-334-9689