Healthcare Provider Details

I. General information

NPI: 1649614231
Provider Name (Legal Business Name): OZARK ORTHOPAEDICS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2013
Last Update Date: 07/06/2020
Certification Date: 07/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603-2 N PROGRESS AVE STE 600
SILOAM SPRINGS AR
72761-4610
US

IV. Provider business mailing address

3317 N WIMBERLY DR
FAYETTEVILLE AR
72703-4056
US

V. Phone/Fax

Practice location:
  • Phone: 479-524-6188
  • Fax: 479-444-6942
Mailing address:
  • Phone: 479-521-2752
  • Fax: 479-521-4603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: TRACY DAVENPORT
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 479-587-3149