Provider Demographics
NPI:1629249883
Name:OZARK WELLNESS INC
Entity Type:Organization
Organization Name:OZARK WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:G
Authorized Official - Last Name:COUTTS
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:870-431-4371
Mailing Address - Street 1:PO BOX 42
Mailing Address - Street 2:
Mailing Address - City:LAKEVIEW
Mailing Address - State:AR
Mailing Address - Zip Code:72642-0042
Mailing Address - Country:US
Mailing Address - Phone:870-431-4371
Mailing Address - Fax:
Practice Address - Street 1:4898 HWY 178 W
Practice Address - Street 2:
Practice Address - City:LAKEVIEW
Practice Address - State:AR
Practice Address - Zip Code:72642-0042
Practice Address - Country:US
Practice Address - Phone:870-431-4371
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR-E-1525261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5K728Medicare PIN