Healthcare Provider Details

I. General information

NPI: 1871084913
Provider Name (Legal Business Name): OZARK TRI-COUNTY HEALTH CARE CONSORTIUM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2018
Last Update Date: 05/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 N JEFFERSON ST
NEOSHO MO
64850-1546
US

IV. Provider business mailing address

PO BOX 758
NEOSHO MO
64850-0758
US

V. Phone/Fax

Practice location:
  • Phone: 417-451-2255
  • 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 State

VIII. Authorized Official

Name: SHEILA R LONG
Title or Position: CFO
Credential:
Phone: 417-451-9450