MEDICARE: OZARK 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	261Q00000X	Clinic/Center	2015021629	MO

General Provider Information

NPI Number	:	1942746912
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OZARK HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	164 COUNTY ROAD 4190
Second Line	:
City	:	SALEM
State	:	MO
Zip	:	65560-8286
Country	:	US
Telephone Number	:	312-953-5636
Fax Number	:

Provider Business Practice Location Address
First Line	:	7505 E 87TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64138-3917
Country	:	US
Telephone Number	:	573-201-0356
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ANDREA JASDANWALA
Credential	:	FNP
Telephone Number	:	573-201-0356

Provider Enumeration Date	:	01/13/2017
Last Update Date	:	01/06/2025

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Directions to “OZARK HEALTHCARE LLC ” Practice Location

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