Healthcare Provider Details

I. General information

NPI: 1841800216
Provider Name (Legal Business Name): OZARKS MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2020
Last Update Date: 11/13/2020
Certification Date: 11/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 INDEPENDENCE SQ
WEST PLAINS MO
65775-4233
US

IV. Provider business mailing address

PO BOX 1100
WEST PLAINS MO
65775-1100
US

V. Phone/Fax

Practice location:
  • Phone: 417-256-1774
  • Fax: 417-256-1794
Mailing address:
  • Phone: 417-256-9111
  • Fax: 417-256-5838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: BARRYLYN ULMANIS
Title or Position: PROVIDER ENROLLMENT COORDINATOR
Credential:
Phone: 417-257-6792