Provider Demographics
NPI:1457482788
Name:OZARKS MEDICAL CENTER
Entity Type:Organization
Organization Name:OZARKS MEDICAL CENTER
Other - Org Name:OZARKS HEALTHCARE PHARMACY THAYER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:KALEEN
Authorized Official - Last Name:MAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-853-5304
Mailing Address - Street 1:1375 NETTLETON AVE
Mailing Address - Street 2:
Mailing Address - City:THAYER
Mailing Address - State:MO
Mailing Address - Zip Code:65791-8740
Mailing Address - Country:US
Mailing Address - Phone:417-264-7115
Mailing Address - Fax:417-264-9115
Practice Address - Street 1:1375 NETTLETON AVE
Practice Address - Street 2:
Practice Address - City:THAYER
Practice Address - State:MO
Practice Address - Zip Code:65791-8740
Practice Address - Country:US
Practice Address - Phone:417-264-7115
Practice Address - Fax:417-264-9115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR278611407Medicaid
MO600061527Medicaid