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General NPI Number Information
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NPI Number | 1285687509
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Entity Type | Organization
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Legal Business Name | MANSFIELD CLINIC, INC.
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 04/21/2011
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Provider Practice Location Address
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Address Line | 120 SW 2ND AVENUE
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City | AVA
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State | MO
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Zip | 65608
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Country | US
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Telephone | 417-683-6790
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Fax | 417-683-6770
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Provider Business Mailing Address
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Address Line | PO BOX 108
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City | MANSFIELD
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State | MO
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Zip | 65704-0108
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Country | US
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Telephone | 417-924-3066
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Fax | 417-924-3925
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DR. KENNETH H DUGAN
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Credential | M.D.
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Telephone | 417-924-3066
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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