Healthcare Provider Details

I. General information

NPI: 1023156064
Provider Name (Legal Business Name): RADIATION ONCOLOGY OF THE OZARKS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3850 S NATIONAL AVE STE 100
SPRINGFIELD MO
65807-5287
US

IV. Provider business mailing address

3850 S NATIONAL AVE STE 100
SPRINGFIELD MO
65807-5287
US

V. Phone/Fax

Practice location:
  • Phone: 417-269-8926
  • Fax: 417-269-5371
Mailing address:
  • Phone: 417-269-8926
  • Fax: 417-269-5371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateMO

VIII. Authorized Official

Name: MRS. SANDY REYNOLDS
Title or Position: OFFICE MANAGER
Credential:
Phone: 417-269-8936