| Ozark Rural Healthcare Llc | |
|
1003 Hauck Dr Rolla MO 65401-2584 | |
| (312) 953-5636 | |
| Not Available |
| Full Name | Ozark Rural Healthcare Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1003 Hauck Dr, Rolla, Missouri |
| Authorized Official Name and Position | Sarfaraz Jasdanwala (MD) |
| Authorized Official Contact | 3129535636 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ozark Rural Healthcare Llc 1003 Hauck Dr Rolla MO 65401-2584 Ph: (312) 953-5636 | Ozark Rural Healthcare Llc 1003 Hauck Dr Rolla MO 65401-2584 Ph: (312) 953-5636 |
| NPI Number | 1851026439 |
|---|---|
| Provider Enumeration Date | 07/19/2022 |
| Last Update Date | 11/03/2023 |
| Medicare PECOS PAC ID | 1052797602 |
|---|---|
| Medicare Enrollment ID | O20221005000237 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851026439 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | 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 |
| Provider Name | Caisie Nichole Nowack |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275252793 PECOS PAC ID: 4082090386 Enrollment ID: I20221010000944 |
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