Provider Demographics
NPI:1053821322
Name:OZARK PHYSICAL MEDICINE CENTER FOR OPERATIONS OZARK PLAZA AND MEDICAL
Entity Type:Organization
Organization Name:OZARK PHYSICAL MEDICINE CENTER FOR OPERATIONS OZARK PLAZA AND MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:TINSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-686-5510
Mailing Address - Street 1:2725 N WESTWOOD BLVD STE 17
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-2367
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2725 N WESTWOOD BLVD STE 17
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-2367
Practice Address - Country:US
Practice Address - Phone:573-778-9348
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-02
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy