1013246255 NPI number — OZARK CENTER

Table of content: (NPI 1013246255)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013246255 NPI number — OZARK CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OZARK CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
OZARK CENTER TCMDD
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013246255
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2526
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JOPLIN
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64803-2526
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-347-7600
Provider Business Mailing Address Fax Number:
417-347-7608

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2934 MCCLELLAND BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOPLIN
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64804-1632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-347-7580
Provider Business Practice Location Address Fax Number:
417-347-7582
Provider Enumeration Date:
12/17/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PARRIGON
Authorized Official First Name:
MARY
Authorized Official Middle Name:
B.
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
417-347-7600

Provider Taxonomy Codes

  • Taxonomy code: 261QD1600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)