Provider Demographics
NPI:1164897161
Name:OZARKS RESOURCE GROUP
Entity Type:Organization
Organization Name:OZARKS RESOURCE GROUP
Other - Org Name:OZARKS COMMUNITY HEALTH CENTER - MILES FOR SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:D
Authorized Official - Last Name:CROUCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-745-2121
Mailing Address - Street 1:PO BOX 125
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:MO
Mailing Address - Zip Code:65668-0125
Mailing Address - Country:US
Mailing Address - Phone:417-745-2121
Mailing Address - Fax:417-745-0056
Practice Address - Street 1:203 E. BROADWAY ST.
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613
Practice Address - Country:US
Practice Address - Phone:417-328-6334
Practice Address - Fax:417-326-8111
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OZARKS RESOURCE GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-12-02
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1639421050Medicaid