Healthcare Provider Details

I. General information

NPI: 1790038511
Provider Name (Legal Business Name): OZARK CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2012
Last Update Date: 11/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3230 WISCONSIN AVE
JOPLIN MO
64804-4029
US

IV. Provider business mailing address

3230 WISCONSIN AVE
JOPLIN MO
64804-4029
US

V. Phone/Fax

Practice location:
  • Phone: 417-347-7600
  • Fax: 417-347-7608
Mailing address:
  • Phone: 417-347-7600
  • Fax: 417-347-7608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MARY PARRIGON
Title or Position: CFO
Credential:
Phone: 417-347-7600