# OZARK ORTHOPAEDICS, P.A.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** OZARK ORTHOPAEDIC AND SPORTS MEDICINE, Orthopaedic Clinic, Ltd.
- **Organization subpart:** No

## Provider details

- **NPI number:** 1649210584
- **Authorized official:** TRACY DAVENPORT (CHIEF OPERATING OFFICER)
- **Authorized official phone:** (479) 587-3149

## Contact information

- **Practice address:** 3317 N WIMBERLY DR, FAYETTEVILLE, AR 72703-4056
- **Practice address phone:** (479) 521-2752
- **Practice address fax:** (479) 521-4603
- **Mailing address:** PO BOX 1608, FAYETTEVILLE, AR 72702
- **Mailing address phone:** (479) 521-2752
- **Mailing address fax:** (479) 444-6942

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | MC-0077 | AR | Yes |
| 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

- **Enumeration date:** 06/08/2006
- **Last updated:** 04/27/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 106296002 | — | AR |
| 01 | — | 205331716 | MEDICAID DME FOR SILOAM SPRINGS CLINIC | AR |