Dr Clinton H Clark, DPM | |
520 S Eagle Rd, Ste 1243, Meridian, ID 83642-6351 | |
(208) 938-4670 | |
Not Available |
Full Name | Dr Clinton H Clark |
---|---|
Gender | Male |
Speciality | Podiatry |
Experience | 37 Years |
Location | 520 S Eagle Rd, Meridian, Idaho |
Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
Identifier | Type | State | Issuer |
---|---|---|---|
1710924345 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
213ES0103X | Podiatrist - Foot & Ankle Surgery | P191 (Idaho) | Primary |
Facility Name | Location | Facility Type |
---|---|---|
St Luke's Regional Medical Center | Boise, ID | Hospital |
Group Practice Name | Group PECOS PAC ID | No. of Members |
---|---|---|
St Lukes Clinic-treasure Valley Llc | 4981878402 | 991 |
Provider Name | St Lukes Clinic-treasure Valley Llc |
---|---|
Provider Type | Part B Supplier - Clinic/group Practice |
Provider Identifiers | NPI Number: 1326336058 PECOS PAC ID: 4981878402 Enrollment ID: O20111119000045 |
Mailing Address | Practice Location Address |
---|---|
Dr Clinton H Clark, DPM 190 E Bannock St, Boise, ID 83712-6241 Ph: (208) 381-2222 | Dr Clinton H Clark, DPM 520 S Eagle Rd, Ste 1243, Meridian, ID 83642-6351 Ph: (208) 938-4670 |
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