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General NPI Number Information
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NPI Number | 1700661188
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Entity Type | Organization
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Legal Business Name | OZARK FAMILY MEDICAL CLINIC LLC
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Dates
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Enumeration Date | 08/25/2023
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Last Update Date | 10/20/2023
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Provider Practice Location Address
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Address Line | 103 DOLLIE LN STE 1
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City | VAN BUREN
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State | MO
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Zip | 63965-7266
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Country | US
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Telephone | 573-850-4110
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Fax |
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Provider Business Mailing Address
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Address Line | 2725 N WESTWOOD BLVD
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City | POPLAR BLUFF
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State | MO
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Zip | 63901-2346
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Country | US
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Telephone | 573-686-5510
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AUSTIN 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 | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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