Healthcare Provider Details

I. General information

NPI: 1326213406
Provider Name (Legal Business Name): OZARKS MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 04/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC 1 BOX 31
GAINESVILLE MO
65655-9601
US

IV. Provider business mailing address

PO BOX 1100
WEST PLAINS MO
65775-1100
US

V. Phone/Fax

Practice location:
  • Phone: 417-679-3624
  • Fax:
Mailing address:
  • Phone: 417-257-6701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number153001
License Number StateMO

VIII. Authorized Official

Name: MRS. JEANNIE LOOPER
Title or Position: INTERIM CEO
Credential:
Phone: 417-257-9111