1992760342 NPI number — OZARK HEALTH, INC

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 1992760342 NPI number — OZARK HEALTH, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OZARK HEALTH, INC
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:
OZARK HEALTH MEDICAL CENTER
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:
1992760342
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 206
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLINTON
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72031-0206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-745-7000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2500 HIGHWAY 65 S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLINTON
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72031-6588
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-745-7000
Provider Business Practice Location Address Fax Number:
501-745-2472
Provider Enumeration Date:
04/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DEATON
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
501-745-9531

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  AR4323 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282NC0060X , with the licence number: AR4237 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 314000000X , with the licence number: 203 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 11313 . This is a "ARBCBS PROVIDER ID" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 119624311 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 17167 . This is a "ARBCBS HOME HEALTH ID" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 106200105 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 135138514 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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