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General NPI Number Information
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NPI Number | 1679600936
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Entity Type | Organization
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Legal Business Name | OZARKS MEDICAL CENTER
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 09/23/2014
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Provider Practice Location Address
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Address Line | 172 HWY 62 EAST SUITE 1
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City | SALEM
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State | AR
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Zip | 72576
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Country | US
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Telephone | 870-895-1911
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Fax | 870-895-4244
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Provider Business Mailing Address
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Address Line | PO BOX 1100
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City | WEST PLAINS
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State | MO
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Zip | 65775-1100
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Country | US
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Telephone | 870-895-1911
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Fax | 870-895-4244
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | THOMAS KELLER
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Credential |
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Telephone | 417-257-9111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | 17447
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License Number State | MO
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