Healthcare Provider Details

I. General information

NPI: 1487020418
Provider Name (Legal Business Name): OZARK TRI-COUNTY HEALTH CARE CONSORTIUM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2015
Last Update Date: 11/04/2022
Certification Date: 11/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 W 10TH ST
LAMAR MO
64759
US

IV. Provider business mailing address

PO BOX 758
NEOSHO MO
64850-0758
US

V. Phone/Fax

Practice location:
  • Phone: 417-451-0619
  • Fax:
Mailing address:
  • Phone: 417-451-0619
  • Fax: 417-451-8903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateMO

VIII. Authorized Official

Name: DON M MCBRIDE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 417-451-0619