| Clark Family Medicine, Llc | |
|
1200 E Woodhurst Dr Suite Q-200 Springfield MO 65804-4261 | |
| (417) 881-5639 | |
| (417) 881-5664 |
| Full Name | Clark Family Medicine, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1200 E Woodhurst Dr, Springfield, Missouri |
| Authorized Official Name and Position | Jonathan Lee Clark (PHYSICIAN) |
| Authorized Official Contact | 4178815639 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Clark Family Medicine, Llc 1200 E Woodhurst Dr Suite Q-200 Springfield MO 65804-4261 Ph: (417) 881-5639 | Clark Family Medicine, Llc 1200 E Woodhurst Dr Suite Q-200 Springfield MO 65804-4261 Ph: (417) 881-5639 |
| NPI Number | 1841435138 |
|---|---|
| Provider Enumeration Date | 12/16/2008 |
| Last Update Date | 12/16/2008 |
| Medicare PECOS PAC ID | 9436212826 |
|---|---|
| Medicare Enrollment ID | O20090112000323 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841435138 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Jonathan Lee Clark |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164415204 PECOS PAC ID: 1456412667 Enrollment ID: I20220727003379 |
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