| Clark Clinic, Inc | |
|
36 Second St Morton MS 39117-3424 | |
| (601) 732-8612 | |
| (601) 732-1957 |
| Full Name | Clark Clinic, Inc |
|---|---|
| Speciality | Clinic/center - Rural Health |
| Location | 36 Second St, Morton, Mississippi |
| Authorized Official Name and Position | Howard D Clark (MEDICAL DIRECTOR) |
| Authorized Official Contact | 6017328612 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Clark Clinic, Inc 36 Second St Morton MS 39117-3424 Ph: (601) 732-8612 | Clark Clinic, Inc 36 Second St Morton MS 39117-3424 Ph: (601) 732-8612 |
| NPI Number | 1982629705 |
|---|---|
| Provider Enumeration Date | 07/13/2006 |
| Last Update Date | 01/14/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982629705 | NPI | - | NPPES |
| 09014545 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | 03575 (Mississippi) | Primary |
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