Provider Demographics
NPI:1558497917
Name:OZARKS MEDICAL CENTER
Entity Type:Organization
Organization Name:OZARKS MEDICAL CENTER
Other - Org Name:OZARKS HEALTHCARE WINONA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER ENROLLMENT COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:BARRYLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:ULMANIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-257-6792
Mailing Address - Street 1:PO BOX 28
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-0028
Mailing Address - Country:US
Mailing Address - Phone:573-325-4237
Mailing Address - Fax:573-325-4996
Practice Address - Street 1:9104 STATE HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MO
Practice Address - Zip Code:65588-8389
Practice Address - Country:US
Practice Address - Phone:573-325-4237
Practice Address - Fax:573-325-4996
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OZARKS MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-27
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO17447261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO590492104Medicaid
MO590492104Medicaid