Healthcare Provider Details

I. General information

NPI: 1649306002
Provider Name (Legal Business Name): OZARKS MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 11/12/2020
Certification Date: 11/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 S MAIN STREET
MAMMOTH SPRING AR
72554-7466
US

IV. Provider business mailing address

PO BOX 250
MAMMOTH SPRING AR
72554-0250
US

V. Phone/Fax

Practice location:
  • Phone: 870-625-3228
  • Fax: 870-625-3227
Mailing address:
  • Phone: 870-625-3228
  • Fax: 870-625-3227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number17447
License Number StateMO

VIII. Authorized Official

Name: THOMAS KELLER
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 417-256-9111