Healthcare Provider Details

I. General information

NPI: 1629156971
Provider Name (Legal Business Name): SKAGGS COMMUNITY HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 BRANSON HILLS PKWY STE 100
BRANSON MO
65616-9908
US

IV. Provider business mailing address

PO BOX 7411626
CHICAGO IL
60674-5626
US

V. Phone/Fax

Practice location:
  • Phone: 417-348-8964
  • Fax: 417-336-0275
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. WILLIAM K MAHONEY
Title or Position: CHIEF EXECXUTIVE OFFICER
Credential:
Phone: 417-335-7270