MEDICARE: OZARK TRI-COUNTY HEALTH CARE CONSORTIUM

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	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1891452835
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OZARK TRI-COUNTY HEALTH CARE CONSORTIUM

Provider Business Mailing Address
First Line	:	PO BOX 758
Second Line	:
City	:	NEOSHO
State	:	MO
Zip	:	64850-0758
Country	:	US
Telephone Number	:	417-451-9450
Fax Number	:	417-451-8903

Provider Business Practice Location Address
First Line	:	805 BROADWAY ST
Second Line	:
City	:	LAMAR
State	:	MO
Zip	:	64759-1224
Country	:	US
Telephone Number	:	417-262-6070
Fax Number	:	417-262-6071

Authorized Official
Title or Position	:	CEO
Name	:	DONALD M MCBRIDE
Credential	:
Telephone Number	:	417-451-9450

Provider Enumeration Date	:	11/24/2021
Last Update Date	:	09/09/2024

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