OZARKS MEDICAL CENTER (NPI# 1649712712) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649712712 |
| Entity Type | Organization |
| Organization Name | OZARKS MEDICAL CENTER |
| Other Organization Name | OMC CERTIFIED COMMUNITY BHC |
| Practice Address |
1211 Porter Wagoner Blvd #23 Parkway West Plains MO 65775-1826 |
| Mailing Address |
Po Box 1100 West Plains MO 65775-1100 |
| Practice Telephone | 4172576762 |
| Practice Fax Number | 4172575875 |
| Mailing Telephone | 4172569111 |
| Mailing Fax Number | 4172575947 |
| Enumeration Date | 2016-11-07 |
| Last Update Date | 2016-11-07 |
| Authorized Official Name | THOMAS KELLER (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Telephone | 4172569111 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
Allopathic & Osteopathic Physicians | ||
| Y | 261QM0850X |
Clinic/Center Specialization: Adult Mental Health |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| OMC Certified Community BHC | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598373359 | Ozarks Medical Center | Clinic/Center | Omc/zizzer Clinic, 1013 College Street, West Plains, MO 65775 | 2020-07-17 |
| 1427526565 | Ozarks Medical Center | Clinic/Center | 201 West High Street, Suite 2, Willow Springs, MO 65793 | 2018-11-07 |
| 1124514476 | Ozarks Medical Center | Clinic/Center | 201 West High Street, Suite 2, Willow Springs, MO 65793 | 2018-07-10 |
| 1780959684 | Ozarks Medical Center | Pharmacy | 18 Parkway Center, West Plains, MO 65775 | 2012-03-12 |
| 1750680146 | Ozarks Medical Center | Internal Medicine | 1115 Alaska St Ste 215, West Plains, MO 65775-2014 | 2011-03-24 |
| 1326213406 | Ozarks Medical Center | Ambulance | Hc 1 Box 31, Gainesville, MO 65655-9601 | 2008-04-29 |
| 1871768952 | Ozarks Medical Center | Ambulance | 203 Front St, Thayer, MO 65791-1220 | 2008-04-29 |
| 1679600936 | Ozarks Medical Center | Clinic/Center | 172 Hwy 62 East, Suite 1, Salem, AR 72576 | 2007-02-27 |
| 1649306002 | Ozarks Medical Center | Clinic/Center | 260 S Main Street, Mammoth Spring, AR 72554-7466 | 2007-02-27 |
| 1730215195 | Ozarks Medical Center | Clinic/Center | 1375 Nettleton Avenue, Thayer, MO 65791 | 2007-02-27 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | OZARKS MEDICAL CENTER | 1100 Kentucky Ave, West Plains, MO 65775-2029 |
| Street Address |
1211 PORTER WAGONER BLVD #23 PARKWAY |
| City | WEST PLAINS |
| State | MO |
| Zip Code | 65775-1826 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154377422 | Karen Saling | Social Worker | 1211 Porter Wagoner Blvd, West Plains, MO 65775-1826 | 2006-05-26 |
| 1033721758 | Jenna Hampton | Counselor | 1211 Porter Wagoner Blvd, West Plains, MO 65775-1826 | 2020-08-24 |
| 1932718400 | Bailey Hutchinson | Counselor | 1211 Porter Wagoner Blvd, West Plains, MO 65775-1826 | 2020-07-30 |
| 1083248777 | Rebecca Kay Beville | Counselor | 1211 Porter Wagoner Blvd, West Plains, MO 65775-1826 | 2020-03-03 |
| 1033619077 | Jana Ethel Reid | Nurse Practitioner | 1211 Porter Wagoner Blvd, West Plains, MO 65775-1826 | 2018-02-16 |
| 1578087359 | Toni Raee Autrey | Social Worker | 1211 Porter Wagoner Blvd, West Plains, MO 65775-1826 | 2017-08-02 |
| 1932511177 | Kenneth Scott Tombley | Counselor | 1211 Porter Wagoner Blvd, #23, West Plains, MO 65775-1826 | 2014-05-22 |
| 1558611129 | Aniefiok Agarin | Psychiatry & Neurology | 1211 Porter Wagoner Blvd, #23, Parkway, West Plains, MO 65775 | 2012-09-11 |
| 1184921496 | Myriah Dawn Wallace | Counselor | 1211 Porter Wagoner Blvd, West Plains, MO 65775-1826 | 2011-02-23 |
| 1629104104 | Ozarks Medical Center | Clinic/Center | 1211 Porter Wagoner Blvd, #23 Parkway Center, West Plains, MO 65775-1826 | 2007-02-26 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598373359 | Ozarks Medical Center | Clinic/Center | Omc/zizzer Clinic, 1013 College Street, West Plains, MO 65775 | 2020-07-17 |
| 1962958678 | Fanny Ray | Massage Therapist | 1105 Independence Drive, West Plains, MO 65775 | 2016-09-01 |
| 1295184166 | Shaunda Faye Wolfe | Case Manager/Care Coordinator | 2301 K Hwy Apt. 2, West Plains, MO 65775 | 2016-06-10 |
| 1740694009 | Mary Loretta Rogganbuck | Counselor | 1211 Porter Wagoner #23, West Plains, MO 65775 | 2014-06-16 |
| 1548673858 | John Tollenaar | Physical Therapist | 1480 8th Streeet, West Plains, MO 65775 | 2014-06-04 |
| 1861818080 | Raymond Eugene Richardson | Case Manager/Care Coordinator | 1015 Lanton Road, West Plains, MO 65775 | 2014-03-12 |
| 1710309083 | Jared M Sadowitz | Physical Therapist | 1100 Kentucly Ave, West Plains, MO 65775 | 2014-01-06 |
| 1346682184 | Mark L. Dake Dds, Msd and David Sander Dmd, Mds | Dentist | 181 N. Kentucky, Suite 300, West Plains, MO 65775 | 2013-07-22 |
| 1427307024 | Anita M. Nelson | Behavioral Analyst | 8388 Pr 2731, West Plains, MO 65775 | 2012-08-29 |
| 1780959684 | Ozarks Medical Center | Pharmacy | 18 Parkway Center, West Plains, MO 65775 | 2012-03-12 |
| Find all providers in zip 65775 | ||||
| Taxonomy Code | 261QM0850X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Adult Mental Health |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults. |
| Notes: [7/1/2003: new] |
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| 1780069161 | Iqbal Psychiatry | Clinic/Center | 1015 Grupp Rd Unit 31035, Saint Louis, MO 63131-5002 | 2015-07-27 |
| Find all providers with the same taxonomy | ||||
| City | WEST PLAINS |
| Zip Code | 65775 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.