Provider Demographics
NPI:1487748034
Name:OZARK HEALTH, INC
Entity type:Organization
Organization Name:OZARK HEALTH, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:DEATON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-745-9531
Mailing Address - Street 1:PO BOX 206
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:AR
Mailing Address - Zip Code:72031-0206
Mailing Address - Country:US
Mailing Address - Phone:501-745-7000
Mailing Address - Fax:501-745-2472
Practice Address - Street 1:428 MEDICAL CENTER PARKWAY
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:AR
Practice Address - Zip Code:72031
Practice Address - Country:US
Practice Address - Phone:501-745-7004
Practice Address - Fax:501-745-5966
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OZARK HEALTH, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-03
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4323251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR17167OtherBCBS
AR135138514Medicaid
AR17167OtherBCBS