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General NPI Number Information
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NPI Number | 1841593571
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Entity Type | Organization
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Legal Business Name | CARDIOLOGY OF THE OZARKS LLC
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Dates
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Enumeration Date | 12/20/2010
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Last Update Date | 03/23/2011
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Provider Practice Location Address
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Address Line | 780 N KENTUCKY AVE
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City | WEST PLAINS
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State | MO
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Zip | 65775-2013
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Country | US
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Telephone | 417-257-2686
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Fax | 417-257-1575
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Provider Business Mailing Address
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Address Line | 780 N KENTUCKY AVE
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City | WEST PLAINS
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State | MO
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Zip | 65775-2013
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Country | US
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Telephone | 417-257-2686
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Fax | 417-257-1575
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ACHENKUNJU K GEORGE
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Credential | M.D.
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Telephone | 417-257-2686
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | MD106574
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License Number State | MO
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