1063620268 NPI number — THE ARC OF THE OZARKS

Table of content: (NPI 1063620268)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063620268 NPI number — THE ARC OF THE OZARKS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE ARC OF THE OZARKS
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:
Provider Other Organization Name Type Code:
6
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:
1063620268
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/24/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1501 E PYTHIAN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65802-2139
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-864-7887
Provider Business Mailing Address Fax Number:
417-864-4307

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
205 N ELM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PIERCE CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65723-1112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-476-2356
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
POWERS
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
417-864-7887

Provider Taxonomy Codes

  • Taxonomy code: 320600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 853078707 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com