Nature Coast Psychiatry PLLC

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

NATURE COAST PSYCHIATRY PLLC

Doing business as

Dr Eilis Clark MD

Practice address

210 S Salisbury Ter
Lecanto, FL 34461-5104

Phone

(352) 631-7460

NPI assigned

Jun 28, 2019

Last updated

Jan 4, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Eilis Clark, MDNPI 1073621215

Title

MGRM

Phone

(352) 631-7460

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Dr Eilis Clark MD Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Eilis Clark, MD

  • Psychiatry Physician
  • Roanoke Rapids, NC
  • NPI 1073621215
  Authorized official Same address or phone

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

{
    "created_epoch": "1561680000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578096000000",
    "number": "1174185276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 S SALISBURY TER",
            "city": "LECANTO",
            "state": "FL",
            "postal_code": "344615104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 S SALISBURY TER",
            "city": "LECANTO",
            "state": "FL",
            "postal_code": "344615104",
            "telephone_number": "352-631-7460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NATURE COAST PSYCHIATRY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-28",
        "last_updated": "2020-01-04",
        "certification_date": "2020-01-04",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "EILIS",
        "authorized_official_title_or_position": "MGRM",
        "authorized_official_telephone_number": "352-631-7460",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "011682400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr Eilis Clark MD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Susannah Cole Nendze, LM
• New Vue, LLC (New Horizons Village)

• Psychiatry Physician in Lecanto, FL
• Providers in Lecanto, FL by specialty
• Psychiatry Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2020; 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.