MEDICARE: BRANSON DIALYSIS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	189725	OTHER	MO	BCBS

General Provider Information

NPI Number	:	1588701239
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRANSON DIALYSIS, LLC

Provider Business Mailing Address
First Line	:	101 SKAGGS RD STE 301
Second Line	:
City	:	BRANSON
State	:	MO
Zip	:	65616-2062
Country	:	US
Telephone Number	:	417-334-8288
Fax Number	:	417-334-6966

Provider Business Practice Location Address
First Line	:	101 SKAGGS RD STE 301
Second Line	:
City	:	BRANSON
State	:	MO
Zip	:	65616-2062
Country	:	US
Telephone Number	:	417-334-8288
Fax Number	:	417-334-6966

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	JULIE A WILLIAMS
Credential	:
Telephone Number	:	417-334-8288

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	11/08/2011

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Directions to “BRANSON DIALYSIS, LLC ” Practice Location

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