Provider Demographics
NPI:1871218099
Name:OZARK RURAL HEALTHCARE LLC
Entity type:Organization
Organization Name:OZARK RURAL HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:SARFARAZ
Authorized Official - Middle Name:ABDEALI
Authorized Official - Last Name:JASDANWALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-953-5636
Mailing Address - Street 1:17781 HORNBEAN DR
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63005-4229
Mailing Address - Country:US
Mailing Address - Phone:312-953-5636
Mailing Address - Fax:
Practice Address - Street 1:3001 WARRIOR LN
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-8685
Practice Address - Country:US
Practice Address - Phone:312-953-5636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center