MEDICARE: OZARK RURAL HEALTHCARE LLC

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	207R00000X	Internal Medicine Physician
2	261QR1300X	Rural Health Clinic/Center

General Provider Information

NPI Number	:	1851026439
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OZARK RURAL HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	1003 HAUCK DR
Second Line	:
City	:	ROLLA
State	:	MO
Zip	:	65401-2584
Country	:	US
Telephone Number	:	312-953-5636
Fax Number	:

Provider Business Practice Location Address
First Line	:	1003 HAUCK DR
Second Line	:
City	:	ROLLA
State	:	MO
Zip	:	65401-2584
Country	:	US
Telephone Number	:	312-953-5636
Fax Number	:

Authorized Official
Title or Position	:	MD
Name	:	SARFARAZ JASDANWALA
Credential	:
Telephone Number	:	312-953-5636

Provider Enumeration Date	:	07/19/2022
Last Update Date	:	11/03/2023

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