Provider Demographics
NPI:1235573577
Name:OZARK ORTHOPAEDICS, P.A.
Entity Type:Organization
Organization Name:OZARK ORTHOPAEDICS, P.A.
Other - Org Name:OTHOPAEDIC CLINIC, LTD.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:PAT
Authorized Official - Last Name:COKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-521-2752
Mailing Address - Street 1:3317 N WIMBERLY DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4056
Mailing Address - Country:US
Mailing Address - Phone:479-521-2752
Mailing Address - Fax:479-521-4603
Practice Address - Street 1:1800 SE MOBERLY LN
Practice Address - Street 2:STE B
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-7017
Practice Address - Country:US
Practice Address - Phone:479-521-2752
Practice Address - Fax:479-521-4603
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OZARK ORTHOPAEDICS, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-17
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR0290210002OtherCIGNA MEDICARE DURABLE MEDICAL EQUIPMENT PTAN