Provider Demographics
NPI:1477960581
Name:OZARK HEALTH, INC
Entity Type:Organization
Organization Name:OZARK HEALTH, INC
Other - Org Name:OZARK MEDICAL CLINIC - FAIRFIELD BAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACCOUNTING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:GENTRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-745-9524
Mailing Address - Street 1:PO BOX 206
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:AR
Mailing Address - Zip Code:72031-0206
Mailing Address - Country:US
Mailing Address - Phone:501-745-9524
Mailing Address - Fax:501-745-9741
Practice Address - Street 1:383 DAVE CREEK PKWY
Practice Address - Street 2:
Practice Address - City:FAIRFIELD BAY
Practice Address - State:AR
Practice Address - Zip Code:72088-3631
Practice Address - Country:US
Practice Address - Phone:501-745-3388
Practice Address - Fax:501-745-3006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-21
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR208447002Medicaid
AR215189729Medicaid