Basic Information
| Provider Information | |||||||||
| NPI: | 1184165490 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | OZARKS NEW HOPE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 102 S. HICKORY STREET | ||||||||
| Address2: | |||||||||
| City: | MOUNT VERNON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 65712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4179291872 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2828 N NATIONAL AVE | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 658034306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4178374000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2017 | ||||||||
| LastUpdateDate: | 05/04/2017 | ||||||||
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| AuthorizedOfficialLastName: | BEARDEN | ||||||||
| AuthorizedOfficialFirstName: | STEVE | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4179291872 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | N | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) | 251V00000X | Y | Agencies | Voluntary or Charitable |
No ID Information.