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General NPI Number Information
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NPI Number | 1245186303
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Entity Type | Organization
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Legal Business Name | STILL WATERS MEDICAL CARE
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Dates
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Enumeration Date | 03/10/2026
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Last Update Date | 03/10/2026
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Provider Practice Location Address
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Address Line | 2800 W 76 COUNTRY BLVD STE 16924985
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City | BRANSON
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State | MO
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Zip | 65616-2170
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Country | US
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Telephone | 855-400-3575
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Fax |
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Provider Business Mailing Address
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Address Line | 2800 W 76 COUNTRY BLVD STE 16924985
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City | BRANSON
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State | MO
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Zip | 65616-2170
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. OKWUCHI OGBONNA
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Credential |
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Telephone | 855-400-3575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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