Healthcare Provider Details

I. General information

NPI: 1649712712
Provider Name (Legal Business Name): OZARKS MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2016
Last Update Date: 11/12/2020
Certification Date: 11/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 PORTER WAGONER BLVD #23 PARKWAY
WEST PLAINS MO
65775-1826
US

IV. Provider business mailing address

PO BOX 1100
WEST PLAINS MO
65775-1100
US

V. Phone/Fax

Practice location:
  • Phone: 417-257-6762
  • Fax: 417-257-5875
Mailing address:
  • Phone: 417-256-9111
  • Fax: 417-257-5947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: THOMAS KELLER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 417-256-9111