MEDICARE: OZARKS MEDICAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency	00010413	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	IA000703	OTHER	MO	CAHABA SUBMITTER ID
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487658340
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OZARKS MEDICAL CENTER

Provider Business Mailing Address
First Line	:	812 N KENTUCKY AVE
Second Line	:
City	:	WEST PLAINS
State	:	MO
Zip	:	65775-2023
Country	:	US
Telephone Number	:	417-256-3133
Fax Number	:	417-256-5961

Provider Business Practice Location Address
First Line	:	812 N KENTUCKY AVE
Second Line	:
City	:	WEST PLAINS
State	:	MO
Zip	:	65775-2023
Country	:	US
Telephone Number	:	417-256-3133
Fax Number	:	417-256-5961

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	THOMAS KELLER
Credential	:
Telephone Number	:	417-257-6700

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	02/22/2021

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Directions to “OZARKS MEDICAL CENTER ” Practice Location

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