Provider Demographics
NPI:1134101009
Name:OZARKS MEDICAL CENTER
Entity type:Organization
Organization Name:OZARKS MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:KALEEN
Authorized Official - Last Name:MAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-256-1793
Mailing Address - Street 1:307 N KENTUCKY AVE
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-2074
Mailing Address - Country:US
Mailing Address - Phone:417-256-7533
Mailing Address - Fax:417-256-7825
Practice Address - Street 1:307 N KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-2074
Practice Address - Country:US
Practice Address - Phone:417-256-7533
Practice Address - Fax:417-256-7825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-16
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL2630641OtherNABP
MO608271201Medicaid