Organization
MANSFIELD CLINIC, INC.
Active
Parent organization
MANSFIELD CLINIC, INC.
Other names
PRIME CARE OF AVA
Organization subpart
Yes
Provider details
NPI number
Legal business name
MANSFIELD CLINIC, INC.
Authorized official
DR. KENNETH H DUGAN M.D. (VICE PRESIDENT)
(417) 924-3066
Entity
Organization
Contact information
Practice address
120 SW 2ND AVENUE, AVA, MO 65608
(417) 683-6790
(417) 683-6770
Mailing address
PO BOX 108, MANSFIELD, MO 65704-0108
(417) 924-3066
(417) 924-3925
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
508809506
—
MO
Enumeration date
05/18/2006
Last updated
04/21/2011
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