Provider Demographics
NPI:1104856343
Name:OZARK INTERNAL MEDICINE AND PEDIATRICS
Entity Type:Organization
Organization Name:OZARK INTERNAL MEDICINE AND PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIMMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-745-3033
Mailing Address - Street 1:P O BOX 429
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:AR
Mailing Address - Zip Code:72031
Mailing Address - Country:US
Mailing Address - Phone:501-745-3033
Mailing Address - Fax:501-745-8099
Practice Address - Street 1:175 VOLUNTEERS PKWY
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:AR
Practice Address - Zip Code:72031
Practice Address - Country:US
Practice Address - Phone:501-745-3033
Practice Address - Fax:501-745-8099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR149500002Medicaid
AR149500002Medicaid
AR5C826Medicare PIN