Active NPI
William Todd Clark, CSA
- Surgical Assistant
- Otisco, IN
National Provider Identifier
1407093875
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Assistant
- Practice address
- 305 Greenbriar CT
Otisco, IN 47163-9601 - Phone
- (812) 256-6143
- NPI assigned
- Jan 7, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Assistant | 246ZC0007X | Primary |
Addresses
Primary practice location
305 Greenbriar CT
Otisco, IN 47163-9601
Mailing address
305 Greenbriar CT
Otisco, IN 47163-9601
Phone (812) 256-6143
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1231286400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1231286400000",
"number": "1407093875",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "305 GREENBRIAR CT",
"city": "OTISCO",
"state": "IN",
"postal_code": "471639601",
"telephone_number": "812-256-6143"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "305 GREENBRIAR CT",
"city": "OTISCO",
"state": "IN",
"postal_code": "471639601",
"telephone_number": "812-256-6143"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "WILLIAM",
"middle_name": "TODD",
"credential": "CSA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-01-07",
"last_updated": "2009-01-07",
"status": "A"
},
"taxonomies": [
{
"code": "246ZC0007X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Other, Surgical Assistant",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Otisco, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.