Healthcare Provider Details

I. General information

NPI: 1629249883
Provider Name (Legal Business Name): OZARK WELLNESS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2008
Last Update Date: 03/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4898 HWY 178 W
LAKEVIEW AR
72642-0042
US

IV. Provider business mailing address

PO BOX 42
LAKEVIEW AR
72642-0042
US

V. Phone/Fax

Practice location:
  • Phone: 870-431-4371
  • Fax:
Mailing address:
  • Phone: 870-431-4371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberAR-E-1525
License Number StateAR

VIII. Authorized Official

Name: DR. WILLIAM G COUTTS II
Title or Position: DOCTOR
Credential: M.D.
Phone: 870-431-4371