1295815017 NPI number — OZARKS MEDICAL CENTER

Table of content: (NPI 1295815017)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295815017 NPI number — OZARKS MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OZARKS MEDICAL 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:
OZARKS HEALTHCARE MOUNTAIN VIEW
Provider Other Organization Name Type Code:
3
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:
1295815017
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/12/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 32
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNTAIN VIEW
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65548-0032
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-934-2273
Provider Business Mailing Address Fax Number:
417-934-2332

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
220 N ELM STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MT. VIEW
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65548-7109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-296-6563
Provider Business Practice Location Address Fax Number:
417-926-5820
Provider Enumeration Date:
10/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KELLER
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
W.
Authorized Official Title or Position:
PRESIDENT AND CEO
Authorized Official Telephone Number:
417-256-9111

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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