Provider Demographics
NPI:1144545005
Name:BRANSON MEDICAL SPECIALISTS
Entity type:Organization
Organization Name:BRANSON MEDICAL SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:417-336-3627
Mailing Address - Street 1:800 STATE HIGHWAY 248 BLDG III
Mailing Address - Street 2:
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-3721
Mailing Address - Country:US
Mailing Address - Phone:417-336-3627
Mailing Address - Fax:417-336-3644
Practice Address - Street 1:800 STATE HIGHWAY 248 BLDG III
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-3721
Practice Address - Country:US
Practice Address - Phone:417-336-3627
Practice Address - Fax:417-336-3644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-05
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center