Provider Demographics
NPI:1477751873
Name:OZARK MEDICAL SURGICAL ASSOCIATES LTD
Entity Type:Organization
Organization Name:OZARK MEDICAL SURGICAL ASSOCIATES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:CHRISTIANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:417-881-8818
Mailing Address - Street 1:1335 E INDEPENDENCE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-4262
Mailing Address - Country:US
Mailing Address - Phone:417-881-8818
Mailing Address - Fax:417-886-9836
Practice Address - Street 1:1335 E INDEPENDENCE ST
Practice Address - Street 2:SUITE B
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-4262
Practice Address - Country:US
Practice Address - Phone:417-881-8818
Practice Address - Fax:417-886-9836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR2C53207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO990000500Medicare ID - Type Unspecified