Organization
STACEY M JOHNSON MD PA
Active
Other names
Physicians Medical Center of the Ozarks
Organization subpart
No
Provider details
NPI number
Authorized official
PETE ROSS (COO VP OF OPERATIONS)
(870) 425-6212
Entity
Organization
Contact information
Practice address
# 17 MEDICAL PLAZA, MOUNTAIN HOME, AR 72653
(870) 425-6212
(870) 424-3774
Mailing address
# 17 MEDICAL PLAZA, MOUNTAIN HOME, AR 72653
(870) 425-6212
(870) 424-3774
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
R2724
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
111814002
—
AR
01
—
57598
AR BCBS PROV
AR
Enumeration date
08/18/2006
Last updated
05/29/2008
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