Provider Demographics
NPI:1770850794
Name:OZARKS FAMILY HEALTH LLC
Entity Type:Organization
Organization Name:OZARKS FAMILY HEALTH LLC
Other - Org Name:OZARKS FAMILY HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LESTER
Authorized Official - Middle Name:L
Authorized Official - Last Name:CONDUFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:417-551-4810
Mailing Address - Street 1:4941 N TOWNE CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-8280
Mailing Address - Country:US
Mailing Address - Phone:417-551-4810
Mailing Address - Fax:417-551-4814
Practice Address - Street 1:4941 N TOWNE CENTRE DR
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:MO
Practice Address - Zip Code:65721-8280
Practice Address - Country:US
Practice Address - Phone:417-551-4810
Practice Address - Fax:417-551-4814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-18
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
MOMD119653207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO204660740Medicaid
MO420074358Medicaid
MO204691323Medicaid
MO204660740Medicaid