Healthcare Provider Details

I. General information

NPI: 1598463572
Provider Name (Legal Business Name): OZARK PELVIC HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2023
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 MEDICAL PLZ STE 10
MOUNTAIN HOME AR
72653-2918
US

IV. Provider business mailing address

19 MEDICAL PLZ STE 10
MOUNTAIN HOME AR
72653-2962
US

V. Phone/Fax

Practice location:
  • Phone: 870-232-0948
  • Fax: 870-232-0898
Mailing address:
  • Phone: 870-232-0948
  • Fax: 870-232-0898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM COREY SMITH
Title or Position: MANAGING MEMBER/AUTHORIZED OFFICIAL
Credential: MD
Phone: 870-232-0948