Clear Water Medical LLC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

101955 Issued in NC

Legal business name

CLEAR WATER MEDICAL LLC

Practice address

4912 Lake Renaissance Cir
Wilmington, NC 28409-3303

Phone

(910) 465-2783

Fax

(910) 794-4531

NPI assigned

Dec 1, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

William Anthony Gore, PA

Title

Managing Member

Phone

(910) 465-2783

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1291161600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1291161600000",
    "number": "1043512783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 16310",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284086310",
            "telephone_number": "910-465-2783",
            "fax_number": "910-794-4531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4912 LAKE RENAISSANCE CIR",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284093303",
            "telephone_number": "910-465-2783",
            "fax_number": "910-794-4531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEAR WATER MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-01",
        "last_updated": "2010-12-01",
        "status": "A",
        "authorized_official_last_name": "GORE",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "ANTHONY",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "910-465-2783",
        "authorized_official_credential": "PA"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "101955",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Francis Clawson, OT
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• Clear Speech Therapy, PC
• Emily Clegg, MS, RD, LD
• Heather R Clelland, PHARMD
• Courtney Elizabeth Clement Bowles, LCMHC-A
• Caroline M Clements, PH.D.
• Jan Thomas Clemmons, FNP

• Physician Assistant in Wilmington, NC
• Providers in Wilmington, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.