| Ozark Healthcare Llc | |
|
1112 S Main St Salem MO 65560-2408 | |
| (573) 739-9806 | |
| Not Available |
| Full Name | Ozark Healthcare Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1112 S Main St, Salem, Missouri |
| Authorized Official Name and Position | Andrea Binkowski (DIRECTOR) |
| Authorized Official Contact | 5737399806 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ozark Healthcare Llc 164 County Road 4190 Salem MO 65560-8286 Ph: (312) 953-5636 | Ozark Healthcare Llc 1112 S Main St Salem MO 65560-2408 Ph: (573) 739-9806 |
| NPI Number | 1942746912 |
|---|---|
| Provider Enumeration Date | 01/13/2017 |
| Last Update Date | 01/26/2017 |
| Medicare PECOS PAC ID | 3375919905 |
|---|---|
| Medicare Enrollment ID | O20221021001707 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942746912 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 2015021629 (Missouri) | Primary |
| Provider Name | Sarfaraz Jasdanwala |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1851646665 PECOS PAC ID: 8426364258 Enrollment ID: I20150825003318 |
| Provider Name | Andrea C Jasdanwala |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619405602 PECOS PAC ID: 9335484369 Enrollment ID: I20181220000184 |
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