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Organization
OZARK ORTHOPAEDICS, P.A.
Active
Organization
OZARK ORTHOPAEDICS, P.A.
Active
Other names
OZARK ORTHOPAEDIC AND SPORTS MEDICINE, Orthopaedic Clinic, Ltd.
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY DAVENPORT (CHIEF OPERATING OFFICER)
(479) 587-3149
Entity
Organization
Contact information
Practice address
3317 N WIMBERLY DR, FAYETTEVILLE, AR 72703-4056
(479) 521-2752
(479) 521-4603
Mailing address
PO BOX 1608, FAYETTEVILLE, AR 72702
(479) 521-2752
(479) 444-6942
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
MC-0077
AR
207XS0106X
Orthopaedic Hand Surgery Physician
—
NULL
207XS0106X
Orthopaedic Hand Surgery Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
NULL
208100000X
Physical Medicine & Rehabilitation Physician
—
—
261QU0200X
Urgent Care Clinic/Center
—
NULL
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
106296002
—
AR
01
—
205331716
MEDICAID DME FOR SILOAM SPRINGS CLINIC
AR
Enumeration date
06/08/2006
Last updated
04/27/2023
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