Healthcare Provider Details

I. General information

NPI: 1003970872
Provider Name (Legal Business Name): AMERIS OF OSCEOLA,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 W LEE AVE
OSCEOLA AR
72370-3001
US

IV. Provider business mailing address

PO BOX 327
BLYTHEVILLE AR
72316-0327
US

V. Phone/Fax

Practice location:
  • Phone: 870-563-7200
  • Fax: 870-838-7100
Mailing address:
  • Phone: 870-838-7300
  • Fax: 870-838-7100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License NumberAR4260
License Number StateAR

VIII. Authorized Official

Name: DAVID LYNN
Title or Position: CFO
Credential:
Phone: 870-838-7462