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General NPI Number Information
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NPI Number | 1942746912
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Entity Type | Organization
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Legal Business Name | OZARK HEALTHCARE LLC
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Dates
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Enumeration Date | 01/13/2017
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Last Update Date | 01/06/2025
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Provider Practice Location Address
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Address Line | 7505 E 87TH ST
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City | KANSAS CITY
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State | MO
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Zip | 64138-3917
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Country | US
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Telephone | 573-201-0356
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Fax |
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Provider Business Mailing Address
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Address Line | 164 COUNTY ROAD 4190
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City | SALEM
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State | MO
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Zip | 65560-8286
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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 | DIRECTOR
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Name | ANDREA JASDANWALA
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Credential | FNP
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Telephone | 573-201-0356
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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 | 2015021629
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License Number State | MO
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