Provider Demographics
NPI:1477967883
Name:MEDICAL DIRECTORS OF THE OZARKS LLC
Entity Type:Organization
Organization Name:MEDICAL DIRECTORS OF THE OZARKS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TERA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-337-4802
Mailing Address - Street 1:PO BOX 1290
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:MO
Mailing Address - Zip Code:65673-1290
Mailing Address - Country:US
Mailing Address - Phone:417-337-4802
Mailing Address - Fax:417-332-2116
Practice Address - Street 1:302 VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-2091
Practice Address - Country:US
Practice Address - Phone:417-337-4802
Practice Address - Fax:417-332-2116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-13
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty