Organization
DOUGLAS COUNTY PUBLIC HEALTH SERVICES GROUP, INC.
Active
Other names
Missouri Ozarks Community Health
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER HEINLEIN (HRO)
(417) 683-4831
Entity
Organization
Contact information
Practice address
804 N HIGHWAY 5, MANSFIELD, MO 65704-7301
(417) 924-8809
(417) 924-8870
Mailing address
504 NW 10TH AVE., PO BOX 1359, AVA, MO 65608
(417) 683-4831
(417) 683-1602
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
2010015973
MO
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26-1881
MEDICARE PART A
—
05
—
505408526
—
MO
Enumeration date
07/07/2010
Last updated
01/26/2011
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