MEDICARE: OZARK PHYSICAL MEDICINE CENTER FOR OPERATIONS OZARK PLAZA AND MEDICAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1528515848
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OZARK PHYSICAL MEDICINE CENTER FOR OPERATIONS OZARK PLAZA AND MEDICAL

Provider Business Mailing Address
First Line	:	2725 N WESTWOOD BLVD STE 16
Second Line	:
City	:	POPLAR BLUFF
State	:	MO
Zip	:	63901-2367
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2725 N WESTWOOD BLVD STE 16
Second Line	:
City	:	POPLAR BLUFF
State	:	MO
Zip	:	63901-2367
Country	:	US
Telephone Number	:	573-429-3316
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ASHLEY TINSLEY
Credential	:
Telephone Number	:	573-686-5510

Provider Enumeration Date	:	09/02/2016
Last Update Date	:	06/07/2017

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