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DSH260078D OZARKS MEDICAL CENTER (Terminated)
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Main Details
Name
OZARKS MEDICAL CENTER
Subdivision Name
MAMMOTH SPRINGS MEDICAL CLINIC
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH260078D
Medicare Provider Number
260078
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
6/3/2010
Participating Start Date
7/1/2010
Participating Approval Date
6/18/2010
Last Recertification Date
11/27/2017
Termination Date
Termination Reason
7/1/2018
Site closure
Contacts
Authorizing Official
Ozarks Medical Center
Nichole Cook, Vice President of Finance
(417) 256-9111 Ext: 6010
Primary Contact
Ozarks Medical Center
Tiffany Poulette, Director of Pharmacy
(417) 257-6782 Ext: 5837
Addresses
Street Address
236 S. MAIN ST
MAMMOTH SPRINGS, AR 72554
Billing Address
Ozarks Medical Center
PO Box 1100
West Plains, MO 65775
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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