1669908042 NPI number — THE ARC OF THE OZARKS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669908042 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:
1669908042
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/19/2022
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:
19401 E US HIGHWAY 40
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
INDEPENDENCE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64055-5451
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-929-8129
Provider Business Practice Location Address Fax Number:
816-929-8165
Provider Enumeration Date:
05/04/2017

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: 320900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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