Provider Demographics
NPI:1730605312
Name:LAKE OF THE OZARKS LASER PAIN CENTER LLC
Entity type:Organization
Organization Name:LAKE OF THE OZARKS LASER PAIN CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:ADAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-587-9046
Mailing Address - Street 1:PO BOX 268
Mailing Address - Street 2:
Mailing Address - City:CAMDENTON
Mailing Address - State:MO
Mailing Address - Zip Code:65020-0268
Mailing Address - Country:US
Mailing Address - Phone:573-873-2755
Mailing Address - Fax:573-873-2756
Practice Address - Street 1:1039 E US HIGHWAY 54 STE 100
Practice Address - Street 2:
Practice Address - City:CAMDENTON
Practice Address - State:MO
Practice Address - Zip Code:65020-6852
Practice Address - Country:US
Practice Address - Phone:573-873-2755
Practice Address - Fax:573-873-2756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-16
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain