MEDICARE: FERRELL DUNCAN CLINIC, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1326099383
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FERRELL DUNCAN CLINIC, INC

Provider Business Mailing Address
First Line	:	1001 E PRIMROSE ST
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65807-5155
Country	:	US
Telephone Number	:	417-875-3434
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 E PRIMROSE ST
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65807-5155
Country	:	US
Telephone Number	:	417-875-3434
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. CHARLES MCCRACKEN
Credential	:
Telephone Number	:	417-875-3335

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	08/22/2020

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