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General NPI Number Information
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NPI Number | 1568774503
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Entity Type | Organization
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Legal Business Name | DOUGLAS COUNTY PUBLIC HEALTH SERVICES GROUP, INC.
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Dates
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Enumeration Date | 07/07/2010
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Last Update Date | 01/26/2011
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Provider Practice Location Address
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Address Line | 804 N HIGHWAY 5
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City | MANSFIELD
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State | MO
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Zip | 65704-7301
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Country | US
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Telephone | 417-924-8809
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Fax | 417-924-8870
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Provider Business Mailing Address
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Address Line | 504 NW 10TH AVE. PO BOX 1359
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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 | 417-683-4831
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Fax | 417-683-1602
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Authorized Official
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Title or Position | HRO
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Name | JENNIFER HEINLEIN
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Credential |
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Telephone | 417-683-4831
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 2010015973
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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