Basic Information
| Provider Information | |||||||||
| NPI: | 1114958006 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SKAGGS COMMUNITY HOSPITAL ASSOCIATION | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | COXHEALTH URGENT CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 525 BRANSON LANDING BLVD | ||||||||
| Address2: | STE 100 | ||||||||
| City: | BRANSON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 656164500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4173488611 | ||||||||
| FaxNumber: | 4173488611 | ||||||||
| Practice Location | |||||||||
| Address1: | 545 BRANSON LANDING BLVD | ||||||||
| Address2: | STE 100 | ||||||||
| City: | BRANSON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 656164500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4173488611 | ||||||||
| FaxNumber: | 4173488611 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2006 | ||||||||
| LastUpdateDate: | 01/29/2014 | ||||||||
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| AuthorizedOfficialLastName: | MAHONEY | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4173357000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
ID Information
| ID | Type | State | Issuer | Description | 509053807 | 05 | MO | MEDICAID | DB5966 | 01 | RAILROAD MEDICARE | OTHER | CI2096 | 01 | RAILROAD MEDICARE | OTHER |