Provider Demographics
NPI:1407208903
Name:OZARK MOUNTAIN MEDICAL LLC
Entity Type:Organization
Organization Name:OZARK MOUNTAIN MEDICAL LLC
Other - Org Name:OZARK MOUNTAIN MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER/CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-733-4769
Mailing Address - Street 1:30688 COUNTY ROAD 80
Mailing Address - Street 2:
Mailing Address - City:CROSS TIMBERS
Mailing Address - State:MO
Mailing Address - Zip Code:65634-8491
Mailing Address - Country:US
Mailing Address - Phone:816-605-3816
Mailing Address - Fax:417-351-4135
Practice Address - Street 1:30688 COUNTY ROAD 80
Practice Address - Street 2:
Practice Address - City:CROSS TIMBERS
Practice Address - State:MO
Practice Address - Zip Code:65634-8491
Practice Address - Country:US
Practice Address - Phone:816-605-3816
Practice Address - Fax:417-351-4135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-07
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies