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General NPI Number Information
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NPI Number | 1841313475
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Entity Type | Organization
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Legal Business Name | BRANSON ONCOLOGY CLINIC, L.L.C.
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Dates
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Enumeration Date | 04/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 545 BRANSON LANDING BOULEVARD. SUITE 404
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City | BRANSON
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State | MO
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Zip | 65616
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Country | US
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Telephone | 417-339-5500
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Fax | 417-339-5505
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Provider Business Mailing Address
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Address Line | 545 BRANSON LANDING BLVD. SUITE 404
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City | BRANSON
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State | MO
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Zip | 65616
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Country | US
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Telephone | 417-339-5500
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Fax | 417-339-5505
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Authorized Official
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Title or Position | ORGANIZER OF BRANSON ONCOLOGY CLINI
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Name | DR. PAIROTE JAROONWANICHKUL
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Credential | M.D.
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Telephone | 417-339-5500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 102149
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License Number State | MO
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