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General NPI Number Information
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NPI Number | 1306629894
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Entity Type | Organization
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Legal Business Name | BG2 CLINICAL SERVICES LLC
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Dates
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Enumeration Date | 08/17/2023
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Last Update Date | 06/12/2025
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Provider Practice Location Address
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Address Line | 857 E MAIN ST STE 4
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City | WILLOW SPRINGS
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State | MO
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Zip | 65793-1512
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Country | US
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Telephone | 417-469-7385
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Fax | 417-469-7386
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Provider Business Mailing Address
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Address Line | PO BOX 490
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City | WILLOW SPRINGS
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State | MO
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Zip | 65793-0490
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Country | US
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Telephone | 417-469-7385
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Fax | 417-469-7386
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Authorized Official
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Title or Position | OWNER, DIRECTOR, CREDENTIALING MGR
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Name | DR. BRANDON GREGORY
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Credential | PHARMD
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Telephone | 417-469-7385
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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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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