Healthcare Provider Details

I. General information

NPI: 1285687509
Provider Name (Legal Business Name): MANSFIELD CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 04/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 SW 2ND AVENUE
AVA MO
65608
US

IV. Provider business mailing address

PO BOX 108
MANSFIELD MO
65704-0108
US

V. Phone/Fax

Practice location:
  • Phone: 417-683-6790
  • Fax: 417-683-6770
Mailing address:
  • Phone: 417-924-3066
  • Fax: 417-924-3925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KENNETH H DUGAN
Title or Position: VICE PRESIDENT
Credential: M.D.
Phone: 417-924-3066