Healthcare Provider Details

I. General information

NPI: 1588701239
Provider Name (Legal Business Name): BRANSON DIALYSIS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 11/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 SKAGGS RD STE 301
BRANSON MO
65616-2062
US

IV. Provider business mailing address

101 SKAGGS RD STE 301
BRANSON MO
65616-2062
US

V. Phone/Fax

Practice location:
  • Phone: 417-334-8288
  • Fax: 417-334-6966
Mailing address:
  • Phone: 417-334-8288
  • Fax: 417-334-6966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JULIE A WILLIAMS
Title or Position: ADMINISTRATOR
Credential:
Phone: 417-334-8288