Organization
FAMILY WALK IN CLINIC OF MOUNTAIN GROVE INC
Active
Other names
FAMILY WALK-IN CLINIC OF MTN. GROVE, INC.
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH H DUGAN M.D. (VICE-PRESIDENT)
(417) 926-3743
Entity
Organization
Contact information
Practice address
205 W 3RD ST STE 3, MOUNTAIN GROVE, MO 65711-1600
(417) 926-3743
(417) 926-7625
Mailing address
205 W 3RD ST STE 3, MOUNTAIN GROVE, MO 65711-1600
(417) 926-3743
(417) 926-7625
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
263939
RIVERBEND
MO
05
—
596020800
—
MO
Enumeration date
09/28/2006
Last updated
11/12/2014
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