| Clark Family Clinic, Llc | |
|
649b W Mcneal St Bolivar TN 38008-2519 | |
| (731) 212-3324 | |
| (731) 212-3325 |
| Full Name | Clark Family Clinic, Llc |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 649b W Mcneal St, Bolivar, Tennessee |
| Authorized Official Name and Position | Charlene E Clark (FAMILY NURSE PRACITITIONER) |
| Authorized Official Contact | 9015005766 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Clark Family Clinic, Llc Po Box 342 Bolivar TN 38008-0342 Ph: (901) 500-5766 | Clark Family Clinic, Llc 649b W Mcneal St Bolivar TN 38008-2519 Ph: (731) 212-3324 |
| NPI Number | 1801391719 |
|---|---|
| Provider Enumeration Date | 03/24/2018 |
| Last Update Date | 03/24/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801391719 | NPI | - | NPPES |
| Q008745 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
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