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General NPI Number Information
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NPI Number | 1881607612
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Entity Type | Organization
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Legal Business Name | FORDLAND CLINIC, INC.
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Dates
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Enumeration Date | 08/14/2006
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Last Update Date | 06/19/2019
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Provider Practice Location Address
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Address Line | 1059 BARTON DR
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City | FORDLAND
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State | MO
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Zip | 65652-7350
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Country | US
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Telephone | 417-767-2273
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Fax | 417-767-4054
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Provider Business Mailing Address
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Address Line | 1059 BARTON DR
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City | FORDLAND
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State | MO
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Zip | 65652-7350
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Country | US
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Telephone | 417-767-2273
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Fax | 417-767-4054
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JOAN TWITON
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Credential |
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Telephone | 417-767-2273
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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 | 263865
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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 | 26-1009
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License Number State | MO
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