Provider Demographics
NPI: | 1851026439 |
---|---|
Name: | OZARK RURAL HEALTHCARE LLC |
Entity Type: | Organization |
Organization Name: | OZARK RURAL HEALTHCARE LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | MD |
Authorized Official - Prefix: | |
Authorized Official - First Name: | SARFARAZ |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | JASDANWALA |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 312-953-5636 |
Mailing Address - Street 1: | 1003 HAUCK DR |
Mailing Address - Street 2: | |
Mailing Address - City: | ROLLA |
Mailing Address - State: | MO |
Mailing Address - Zip Code: | 65401-2584 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 312-953-5636 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1003 HAUCK DR |
Practice Address - Street 2: | |
Practice Address - City: | ROLLA |
Practice Address - State: | MO |
Practice Address - Zip Code: | 65401-2584 |
Practice Address - Country: | US |
Practice Address - Phone: | 312-953-5636 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2022-07-19 |
Last Update Date: | 2023-11-03 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 261QR1300X | Ambulatory Health Care Facilities | Clinic/Center | Rural Health | Group - Single Specialty |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Single Specialty |