Healthcare Provider Details

I. General information

NPI: 1619208303
Provider Name (Legal Business Name): SKAGGS-COX HEALTH ALLIANCE, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2010
Last Update Date: 06/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 BRANSON HILLS PKWY
BRANSON MO
65616-9942
US

IV. Provider business mailing address

PO BOX 4046
SPRINGFIELD MO
65808-4046
US

V. Phone/Fax

Practice location:
  • Phone: 417-336-0536
  • Fax: 417-336-0539
Mailing address:
  • Phone: 417-269-5712
  • Fax: 417-269-4869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ROBERT H. BEZANSON
Title or Position: PRESIDENT & CEO
Credential:
Phone: 417-269-3108