Healthcare Provider Details

I. General information

NPI: 1326453408
Provider Name (Legal Business Name): OZARKS RESOURCE GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2014
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18627 JACKSON ST
HERMITAGE MO
65668-8204
US

IV. Provider business mailing address

PO BOX 125
HERMITAGE MO
65668-0125
US

V. Phone/Fax

Practice location:
  • Phone: 417-745-2134
  • Fax: 417-745-2135
Mailing address:
  • Phone: 417-745-2121
  • Fax: 417-745-0056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MR. SCOTT D CROUCH
Title or Position: CEO
Credential:
Phone: 417-745-2121