Provider Demographics
NPI:1518001296
Name:OZARKS MEDICAL CENTER
Entity Type:Organization
Organization Name:OZARKS MEDICAL CENTER
Other - Org Name:OZARKS HEALTHCARE PHARMACY GAINESVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:KALEEN
Authorized Official - Last Name:MAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:417-505-7700
Mailing Address - Street 1:PO BOX 414
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65655-0414
Mailing Address - Country:US
Mailing Address - Phone:417-679-2650
Mailing Address - Fax:417-679-2596
Practice Address - Street 1:512 THIRD STREET
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:MO
Practice Address - Zip Code:65655-0414
Practice Address - Country:US
Practice Address - Phone:417-679-2650
Practice Address - Fax:417-679-2596
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OZARKS MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20001520043336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO604867606Medicaid