Provider Demographics
NPI:1831815695
Name:MANSFIELD ACCIDENT & INJURY CENTER, LLC
Entity type:Organization
Organization Name:MANSFIELD ACCIDENT & INJURY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAUDILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-302-2744
Mailing Address - Street 1:128 SOUTHERN MANOR RD
Mailing Address - Street 2:
Mailing Address - City:VANCEBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41179-7511
Mailing Address - Country:US
Mailing Address - Phone:740-302-2744
Mailing Address - Fax:
Practice Address - Street 1:432 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-5002
Practice Address - Country:US
Practice Address - Phone:419-522-4672
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty