1679600936 NPI number — OZARKS MEDICAL CENTER

Table of content: (NPI 1679600936)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679600936 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:
SALEM 1ST CARE
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:
1679600936
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/23/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST PLAINS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65775-1100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-895-1911
Provider Business Mailing Address Fax Number:
870-895-4244

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
172 HWY 62 EAST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72576
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-895-1911
Provider Business Practice Location Address Fax Number:
870-895-4244
Provider Enumeration Date:
02/27/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KELLER
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT AND CEO
Authorized Official Telephone Number:
417-257-9111

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , with the licence number:  17447 , 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)

  • Identifier: 118739729 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 592967509 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".