Healthcare Provider Details

I. General information

NPI: 1336155167
Provider Name (Legal Business Name): OZARK SURGICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 04/28/2022
Certification Date: 04/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 BURNETT DR
MOUNTAIN HOME AR
72653-2908
US

IV. Provider business mailing address

901 BURNETT DR
MOUNTAIN HOME AR
72653-2908
US

V. Phone/Fax

Practice location:
  • Phone: 870-425-9120
  • Fax:
Mailing address:
  • Phone: 870-425-9120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SUSAN MARIE SMITH
Title or Position: CODING & BILLING MANAGER
Credential: CCS, CPC, CPMA, CGSC
Phone: 870-425-9120