Provider Demographics
NPI:1124347380
Name:OZARK SENIOR HEALTHCARE, PLLC
Entity type:Organization
Organization Name:OZARK SENIOR HEALTHCARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:BILAL
Authorized Official - Middle Name:E
Authorized Official - Last Name:NAEEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-927-1044
Mailing Address - Street 1:PO BOX 9178
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72811-9178
Mailing Address - Country:US
Mailing Address - Phone:800-824-4094
Mailing Address - Fax:479-968-1673
Practice Address - Street 1:210 S THOMPSON ST STE 4A
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-4261
Practice Address - Country:US
Practice Address - Phone:794-459-9004
Practice Address - Fax:479-213-8142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-26
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE03402207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR148445001Medicaid
P00853324OtherMEDICARE RAILROAD / PALMETTO
AR5G550Medicare PIN