Healthcare Provider Details

I. General information

NPI: 1831791094
Provider Name (Legal Business Name): OZARK CENTER FOR LIFESTYLE MEDICINE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2020
Last Update Date: 12/19/2020
Certification Date: 12/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2894 N MCKEE CIR STE 120
FAYETTEVILLE AR
72703-3498
US

IV. Provider business mailing address

164 NC 9203
PETTIGREW AR
72752
US

V. Phone/Fax

Practice location:
  • Phone: 870-505-4619
  • Fax:
Mailing address:
  • Phone: 870-505-4619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CYNTHIA LOUISE MORGAN
Title or Position: FOUNDER AND EXECUTIVE DIRECTOR
Credential: MD, MPH
Phone: 479-325-4859