Provider Demographics
NPI:1992760342
Name:OZARK HEALTH, INC
Entity type:Organization
Organization Name:OZARK HEALTH, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position: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:
Practice Address - Street 1:2500 HIGHWAY 65 S
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:AR
Practice Address - Zip Code:72031-6588
Practice Address - Country:US
Practice Address - Phone:501-745-7000
Practice Address - Fax:501-745-2472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR4323251E00000X
ARAR4237282NC0060X
AR203314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No251E00000XAgenciesHome Health
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR11313OtherARBCBS PROVIDER ID
AR119624311Medicaid
AR17167OtherARBCBS HOME HEALTH ID
AR106200105Medicaid
AR135138514Medicaid
AR047167Medicare ID - Type UnspecifiedHOME HEALTH PROVIDER ID
AR135138514Medicaid
AR11313OtherARBCBS PROVIDER ID