Provider Demographics
NPI:1043305501
Name:OZARK HEALTH, INC
Entity Type:Organization
Organization Name:OZARK HEALTH, INC
Other - Org Name:OZARK HEALTH EMERGENCY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:DEATON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-745-9531
Mailing Address - Street 1:PO BOX 206
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:AR
Mailing Address - Zip Code:72031-0206
Mailing Address - Country:US
Mailing Address - Phone:501-745-7000
Mailing Address - Fax:501-745-9741
Practice Address - Street 1:2500 HWY 65 S
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:AR
Practice Address - Zip Code:72031
Practice Address - Country:US
Practice Address - Phone:501-745-7000
Practice Address - Fax:501-745-9741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4237261QE0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR122841002Medicaid
AR5B238Medicare ID - Type Unspecified