Provider Demographics
NPI:1487024667
Name:OZARKS RESOURCE GROUP
Entity Type:Organization
Organization Name:OZARKS RESOURCE GROUP
Other - Org Name:OZARKS COMMUNITY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:CROUCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-745-2121
Mailing Address - Street 1:102 E JACKSON ST
Mailing Address - Street 2:PO BOX 125
Mailing Address - City:HERMITAGE
Mailing Address - State:MO
Mailing Address - Zip Code:65668-9231
Mailing Address - Country:US
Mailing Address - Phone:417-745-2121
Mailing Address - Fax:417-745-6141
Practice Address - Street 1:111 N MAIN ST
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:MO
Practice Address - Zip Code:65767-9152
Practice Address - Country:US
Practice Address - Phone:417-745-2121
Practice Address - Fax:417-745-6141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-01
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1639421050Medicaid