Provider Demographics
NPI:1720867369
Name:OZARKS MEDICAL CENTER
Entity Type:Organization
Organization Name:OZARKS MEDICAL CENTER
Other - Org Name:OZARKS HEALTHCARE PHARMACY MOUNTAIN GROVE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:KALEEN
Authorized Official - Last Name:MAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:417-505-7700
Mailing Address - Street 1:500 E 19TH ST STE D
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN GROVE
Mailing Address - State:MO
Mailing Address - Zip Code:65711-1115
Mailing Address - Country:US
Mailing Address - Phone:417-372-8732
Mailing Address - Fax:866-291-1699
Practice Address - Street 1:500 E 19TH ST STE D
Practice Address - Street 2:
Practice Address - City:MOUNTAIN GROVE
Practice Address - State:MO
Practice Address - Zip Code:65711-1115
Practice Address - Country:US
Practice Address - Phone:417-372-8732
Practice Address - Fax:866-291-1699
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OZARKS MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-09-25
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy