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General NPI Number Information
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NPI Number | 1003970872
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Entity Type | Organization
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Legal Business Name | AMERIS OF OSCEOLA,LLC
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 611 W LEE AVE
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City | OSCEOLA
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State | AR
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Zip | 72370-3001
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Country | US
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Telephone | 870-563-7200
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Fax | 870-838-7100
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Provider Business Mailing Address
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Address Line | PO BOX 327
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City | BLYTHEVILLE
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State | AR
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Zip | 72316-0327
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Country | US
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Telephone | 870-838-7300
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Fax | 870-838-7100
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Authorized Official
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Title or Position | CFO
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Name | DAVID LYNN
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Credential |
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Telephone | 870-838-7462
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 275N00000X
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Taxonomy Name | Medicare Defined Swing Bed Hospital Unit
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License Number | AR4260
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License Number State | AR
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