Provider Demographics
NPI:1407590805
Name:MEDICAL GROUP OF THE OZARKS LLC
Entity Type:Organization
Organization Name:MEDICAL GROUP OF THE OZARKS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:BORTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-202-3759
Mailing Address - Street 1:50 W CHAMPIONS BLVD
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-9567
Mailing Address - Country:US
Mailing Address - Phone:479-202-3759
Mailing Address - Fax:
Practice Address - Street 1:311 MORROW ST N
Practice Address - Street 2:
Practice Address - City:MENA
Practice Address - State:AR
Practice Address - Zip Code:71953-2516
Practice Address - Country:US
Practice Address - Phone:479-394-6100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-22
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Single Specialty