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General NPI Number Information
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NPI Number | 1730605312
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Entity Type | Organization
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Legal Business Name | LAKE OF THE OZARKS LASER PAIN CENTER LLC
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Dates
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Enumeration Date | 08/16/2017
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Last Update Date | 02/13/2019
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Provider Practice Location Address
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Address Line | 1039 E US HIGHWAY 54 STE 100
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City | CAMDENTON
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State | MO
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Zip | 65020-6852
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Country | US
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Telephone | 573-873-2755
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Fax | 573-873-2756
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Provider Business Mailing Address
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Address Line | PO BOX 268
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City | CAMDENTON
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State | MO
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Zip | 65020-0268
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Country | US
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Telephone | 573-873-2755
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Fax | 573-873-2756
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Authorized Official
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Title or Position | PRESIDENT
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Name | RONALD EUGENE ADAMSON
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Credential |
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Telephone | 573-587-9046
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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