Provider Demographics
NPI:1831791094
Name:OZARK CENTER FOR LIFESTYLE MEDICINE, INC.
Entity type:Organization
Organization Name:OZARK CENTER FOR LIFESTYLE MEDICINE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FOUNDER AND EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:479-325-4859
Mailing Address - Street 1:164 NC 9203
Mailing Address - Street 2:
Mailing Address - City:PETTIGREW
Mailing Address - State:AR
Mailing Address - Zip Code:72752
Mailing Address - Country:US
Mailing Address - Phone:870-505-4619
Mailing Address - Fax:
Practice Address - Street 1:2894 N MCKEE CIR STE 120
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-3498
Practice Address - Country:US
Practice Address - Phone:870-505-4619
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-12
Last Update Date:2020-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Single Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty