| Clark Medical And Post-acute Services, Llc | |
|
10810 N Tatum Blvd Ste 102-107 Phoenix AZ 85028-6055 | |
| (602) 568-4362 | |
| (602) 584-5955 |
| Full Name | Clark Medical And Post-acute Services, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 10810 N Tatum Blvd Ste 102-107, Phoenix, Arizona |
| Authorized Official Name and Position | Randolph Clark (PRESIDENT) |
| Authorized Official Contact | 6025684362 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Clark Medical And Post-acute Services, Llc 10810 N Tatum Blvd Ste 102-107 Phoenix AZ 85028-6055 Ph: (602) 568-4362 | Clark Medical And Post-acute Services, Llc 10810 N Tatum Blvd Ste 102-107 Phoenix AZ 85028-6055 Ph: (602) 568-4362 |
| NPI Number | 1437851417 |
|---|---|
| Provider Enumeration Date | 03/21/2023 |
| Last Update Date | 03/21/2023 |
| Medicare PECOS PAC ID | 5991164402 |
|---|---|
| Medicare Enrollment ID | O20230630001989 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437851417 | NPI | - | NPPES |
| Provider Name | Vinee Srivastava |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1720130628 PECOS PAC ID: 8628070687 Enrollment ID: I20070205000682 |
| Provider Name | Randolph Clark |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1568456036 PECOS PAC ID: 7517916463 Enrollment ID: I20081203000150 |
| Provider Name | Binu Thomas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679012348 PECOS PAC ID: 1951685346 Enrollment ID: I20170302002217 |
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