Provider Demographics
NPI:1356079396
Name:OZARKS MEDICAL CENTER
Entity type:Organization
Organization Name:OZARKS MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-256-9111
Mailing Address - Street 1:18 PARKWAY SHOPPING CTR
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-1840
Mailing Address - Country:US
Mailing Address - Phone:417-505-7900
Mailing Address - Fax:417-691-8052
Practice Address - Street 1:18 PARKWAY SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-1840
Practice Address - Country:US
Practice Address - Phone:417-505-7900
Practice Address - Fax:417-691-8052
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OZARKS MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-09
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO600116990Medicaid