| Organization Name: | FAMILY WALK IN CLINIC OF MOUNTAIN GROVE INC |
| NPI Number: | 1083705529 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KENNETH H DUGAN (VICE-PRESIDENT) |
| Mailing Address: | 205 W 3rd St Ste 3 Mountain Grove |
| State: | MO US |
| Postal Code: | 657111600 |
| Phone Number: | 4179263743 |
| Fax Number: | 4179267625 |
| NPI Enumeration Date: | 09/28/2006 |
| NPI Last Update Date: | 11/12/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR1300X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rural Health |
| Taxonomy Definition: | |