Organization
TRI-LAKES UROLOGY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JERRY SAMUEL GIVENS M.D. (OWNER)
(417) 335-7736
Entity
Organization
Contact information
Practice address
545 BRANSON LANDING BLVD, SUITE 307, BRANSON, MO 65616-4500
(417) 335-7736
(417) 334-3038
Mailing address
PO BOX 751, OKLAHOMA CITY, OK 73101-0751
(405) 858-2350
(405) 858-2365
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
MDR9B09
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1089490001
RAILROAD MEDICARE
MO
01
—
14360
BLUE SHIELD
MO
05
—
152379001
—
AR
05
—
202355806
—
MO
Enumeration date
04/02/2008
Last updated
11/18/2010
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