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General NPI Number Information
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NPI Number | 1871218099
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Entity Type | Organization
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Legal Business Name | OZARK RURAL HEALTHCARE LLC
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Dates
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Enumeration Date | 10/10/2022
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Last Update Date | 10/10/2022
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Provider Practice Location Address
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Address Line | 3001 WARRIOR LN
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City | POPLAR BLUFF
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State | MO
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Zip | 63901-8685
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Country | US
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Telephone | 312-953-5636
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Fax |
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Provider Business Mailing Address
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Address Line | 17781 HORNBEAN DR
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City | WILDWOOD
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State | MO
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Zip | 63005-4229
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Country | US
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Telephone | 312-953-5636
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | SARFARAZ ABDEALI JASDANWALA
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Credential | MD
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Telephone | 312-953-5636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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