Tri-Lakes Urology, Inc

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

MDR9B09 Issued in MO

Legal business name

TRI-LAKES UROLOGY, INC

Practice address

545 Branson Landing Blvd
Suite 307
Branson, MO 65616-4500

Phone

(417) 335-7736

Fax

(417) 334-3038

NPI assigned

Apr 2, 2008

Last updated

Nov 18, 2010By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jerry Samuel Givens, M.D.NPI 1164462412

Title

Owner

Phone

(417) 335-7736

Specialties & licenses 1

Addresses

Other identifiers 4

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jerry Samuel Givens, M.D.

  • Urology Physician
  • Branson, MO
  • NPI 1164462412
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1207094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1290038400000",
    "number": "1942472675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 751",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731010751",
            "telephone_number": "405-858-2350",
            "fax_number": "405-858-2365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "545 BRANSON LANDING BLVD",
            "address_2": "SUITE 307",
            "city": "BRANSON",
            "state": "MO",
            "postal_code": "656164500",
            "telephone_number": "417-335-7736",
            "fax_number": "417-334-3038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI-LAKES UROLOGY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-02",
        "last_updated": "2010-11-18",
        "status": "A",
        "authorized_official_last_name": "GIVENS",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "SAMUEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "417-335-7736",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "MO",
            "license": "MDR9B09",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "152379001",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "1089490001",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "14360",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "202355806",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tri-Lakes Chiropractic Clinic P C
• Tri-Lakes Church (Tri-Lakes Relational Center)
• Tri-Lakes Diagnostic Imaging, LLC
• Tri-Lakes Diagnostic Tech.
• Tri-Lakes Surgery Center, LLC
• Holli Jo Triboulet
• Dustin Ryan Tripp, MD
• Elizabeth Demetra Tsahiridis, MSMHC MSED LPC
• Jeffery L Tucker, OT
• Kevin Donald Umbright, O.D.

• Urology Physician in Branson, MO
• Providers in Branson, MO by specialty
• Urology Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.