Organization
MANSFIELD CLINIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH DUGAN MD (VICE PRESIDENT)
(417) 924-3066
Entity
Organization
Contact information
Practice address
304 WEST COMMERCIAL STREET, MANSFIELD, MO 65704
(417) 924-3066
(417) 924-3925
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
01
—
263940
RIVERBEND GBA
MO
05
—
596020602
—
MO
Enumeration date
02/06/2007
Last updated
04/03/2012
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