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?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty