Provider Demographics
NPI:1700661188
Name:OZARK FAMILY MEDICAL CLINIC LLC
Entity Type:Organization
Organization Name:OZARK FAMILY MEDICAL CLINIC LLC
Other - Org Name:OZARK FAMILY MEDICAL CLINIC, VAN BUREN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:TINSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-686-5510
Mailing Address - Street 1:2725 N WESTWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-2346
Mailing Address - Country:US
Mailing Address - Phone:573-686-5510
Mailing Address - Fax:
Practice Address - Street 1:103 DOLLIE LN STE 1
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:MO
Practice Address - Zip Code:63965-7266
Practice Address - Country:US
Practice Address - Phone:573-850-4110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-25
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health