Organization
BRANSON KIDNEY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JULIE ANN WILLIAMS (ADMINISTRATOR)
(417) 334-8288
Entity
Organization
Contact information
Practice address
17829 BUS 13, BRANSON WEST, MO 65737-9664
(417) 334-8288
(417) 334-6966
Mailing address
17829 BUS 13, BRANSON WEST, MO 65737-2062
(417) 272-0222
(417) 334-6966
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1285109041
—
MO
05
—
236152134
—
AR
01
—
26D2157464
CLIA CERTIFICATE
—
Enumeration date
10/09/2018
Last updated
09/01/2021
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