Provider Demographics
NPI:1376679423
Name:OZARKS MEDICAL CENTER
Entity Type:Organization
Organization Name:OZARKS MEDICAL CENTER
Other - Org Name:OZARKS HEALTHCARE MOUNTAIN GROVE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:W
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-256-9111
Mailing Address - Street 1:PO BOX 1100
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-1100
Mailing Address - Country:US
Mailing Address - Phone:417-256-9111
Mailing Address - Fax:
Practice Address - Street 1:500 EAST 19TH STREET
Practice Address - Street 2:SUITE A
Practice Address - City:MOUNTAIN GROVE
Practice Address - State:MO
Practice Address - Zip Code:65711
Practice Address - Country:US
Practice Address - Phone:417-926-6563
Practice Address - Fax:417-926-5820
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OZARKS MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-25
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO17447261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO599301009Medicaid
MO268579Medicare Oscar/Certification