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General NPI Number Information
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NPI Number | 1669982963
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Entity Type | Organization
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Legal Business Name | OZARK PHYSICAL MEDICINE CENTER FOR OPERATIONS OZARK PLAZA AND MEDICAL
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Dates
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Enumeration Date | 10/02/2017
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Last Update Date | 10/02/2017
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Provider Practice Location Address
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Address Line | 2725 N WESTWOOD BLVD STE 16
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City | POPLAR BLUFF
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State | MO
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Zip | 63901-2367
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Country | US
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Telephone | 573-686-5510
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Fax |
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Provider Business Mailing Address
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Address Line | 2725 N WESTWOOD BLVD STE 16
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City | POPLAR BLUFF
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State | MO
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Zip | 63901-2367
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNDER
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Name | ASHLEY TINSLEY
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Credential |
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Telephone | 573-686-5510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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