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General NPI Number Information
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NPI Number | 1295985968
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Entity Type | Organization
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Legal Business Name | OZARK GASTROENTEROLOGY, INC
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Dates
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Enumeration Date | 09/30/2008
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Last Update Date | 04/24/2014
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Provider Practice Location Address
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Address Line | 2216 E 32ND STREET STE 103
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City | JOPLIN
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State | MO
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Zip | 64804
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Country | US
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Telephone | 417-623-5250
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Fax | 417-623-8302
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Provider Business Mailing Address
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Address Line | 2216 E 32ND STREET STE 103
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City | JOPLIN
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State | MO
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Zip | 64804
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Country | US
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Telephone | 417-623-5250
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Fax | 417-623-8302
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Authorized Official
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Title or Position | OWNER
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Name | DR. SUDHAKAR ANCHA
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Credential | MD
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Telephone | 417-623-5250
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 2005009627
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License Number State | MO
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