Healthcare Provider Details

I. General information

NPI: 1639421050
Provider Name (Legal Business Name): OZARKS RESOURCE GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2012
Last Update Date: 05/29/2024
Certification Date: 05/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18614 JACKSON STREET
HERMITAGE MO
65613-0125
US

IV. Provider business mailing address

PO BOX 125
HERMITAGE MO
65668-0125
US

V. Phone/Fax

Practice location:
  • Phone: 417-745-2121
  • Fax: 417-745-6141
Mailing address:
  • Phone: 417-745-2121
  • Fax: 417-745-0056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

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