Healthcare Provider Details

I. General information

NPI: 1760519029
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

37 MEDICAL DRIVE
GAINESVILLE MO
65655
US

IV. Provider business mailing address

1100 N KENTUCKY AVE PO BOX 1100
WEST PLAINS MO
65775-2029
US

V. Phone/Fax

Practice location:
  • Phone: 417-679-4613
  • Fax: 417-679-2211
Mailing address:
  • Phone: 417-256-9111
  • Fax:

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: 417-257-6700