Healthcare Provider Details

I. General information

NPI: 1306629894
Provider Name (Legal Business Name): BG2 CLINICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2023
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

857 E MAIN ST STE 4
WILLOW SPRINGS MO
65793-1512
US

IV. Provider business mailing address

PO BOX 490
WILLOW SPRINGS MO
65793-0490
US

V. Phone/Fax

Practice location:
  • Phone: 417-469-7385
  • Fax: 417-469-7386
Mailing address:
  • Phone: 417-855-1085
  • Fax: 417-469-7386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BRANDON GREGORY
Title or Position: OWNER, DIRECTOR, CREDENTIALING MGR
Credential: PHARMD
Phone: 417-469-7385