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General NPI Number Information
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NPI Number | 1396079711
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Entity Type | Organization
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Legal Business Name | GOOD SHEPHERD FAMILY CLINIC INC
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Dates
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Enumeration Date | 10/01/2009
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Last Update Date | 10/01/2009
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Provider Practice Location Address
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Address Line | 112 BUSINESS PARK DR
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City | BRANSON
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State | MO
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Zip | 65616-7426
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Country | US
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Telephone | 417-335-5022
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Fax | 417-335-5044
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Provider Business Mailing Address
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Address Line | 112 BUSINESS PARK DR
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City | BRANSON
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State | MO
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Zip | 65616-7426
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Country | US
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Telephone | 417-335-5022
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Fax | 417-335-5044
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. STEPHANIE SUE OLSON
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Credential |
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Telephone | 417-335-5022
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2007021133
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License Number State | MO
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