Healthcare Provider Details

I. General information

NPI: 1326576174
Provider Name (Legal Business Name): BRANSON CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 BUSINESS PARK DR STE C
BRANSON MO
65616-7449
US

IV. Provider business mailing address

110 BUSINESS PARK DR STE C
BRANSON MO
65616-7449
US

V. Phone/Fax

Practice location:
  • Phone: 417-239-0125
  • Fax: 417-239-0127
Mailing address:
  • Phone: 417-239-0125
  • Fax: 417-239-0127

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: DARREN ALLISON
Title or Position: CEO, PRESIDENT
Credential:
Phone: 417-239-0125