1134101009 NPI number — OZARKS MEDICAL CENTER

Table of content: (NPI 1134101009)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134101009 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:
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:
1134101009
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/23/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
307 N KENTUCKY AVE
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:
65775-2074
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-256-7533
Provider Business Mailing Address Fax Number:
417-256-7825

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
307 N KENTUCKY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST PLAINS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65775-2074
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-256-7533
Provider Business Practice Location Address Fax Number:
417-256-7825
Provider Enumeration Date:
11/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MAHAN
Authorized Official First Name:
KATIE
Authorized Official Middle Name:
KALEEN
Authorized Official Title or Position:
DIRECTOR OF PHARMACY
Authorized Official Telephone Number:
417-256-1793

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2630641 . This is a "NABP" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 608271201 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com