Healthcare Provider Details

I. General information

NPI: 1588659411
Provider Name (Legal Business Name): TRI-LAKES SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 HIGHWAY 248 SUITE B
BRANSON MO
65616-8154
US

IV. Provider business mailing address

915 HIGHWAY 248 SUITE B
BRANSON MO
65616-8154
US

V. Phone/Fax

Practice location:
  • Phone: 417-335-8572
  • Fax: 417-335-8573
Mailing address:
  • Phone: 417-335-8572
  • Fax: 417-335-8573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number168-0
License Number StateMO

VIII. Authorized Official

Name: TOM V MORRISON
Title or Position: OWNER/MEDICAL DIRECTOR
Credential: M.D.
Phone: 417-335-8572