Healthcare Provider Details

I. General information

NPI: 1245146141
Provider Name (Legal Business Name): TABLEROCK HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 GRETNA RD STE 110
BRANSON MO
65616-7461
US

IV. Provider business mailing address

3200 GRETNA RD STE 110
BRANSON MO
65616-7461
US

V. Phone/Fax

Practice location:
  • Phone: 417-246-2713
  • Fax: 417-384-4478
Mailing address:
  • Phone: 417-246-2713
  • Fax: 417-384-4478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HANNAH FORREST
Title or Position: OFFICE MANAGER
Credential:
Phone: 417-246-2713