Provider Demographics
NPI:1780959684
Name:OZARKS MEDICAL CENTER
Entity type:Organization
Organization Name:OZARKS MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELYNNI
Authorized Official - Middle Name:
Authorized Official - Last Name:YARBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-256-1793
Mailing Address - Street 1:1100 N KENTUCKY AVE
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-2029
Mailing Address - Country:US
Mailing Address - Phone:417-256-1793
Mailing Address - Fax:417-256-1784
Practice Address - Street 1:1100 N KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-2029
Practice Address - Country:US
Practice Address - Phone:417-256-1793
Practice Address - Fax:417-256-1784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-12
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20040363253336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1780959684Medicaid
2134012OtherPK