Active NPI
Andrea Clark
- Contractor
- Toledo, OH
National Provider Identifier
1407238660
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Contractor
- Practice address
- 2300 Seaman St
Apt. 101
Toledo, OH 43605-1952 - Phone
- (419) 810-2055
- NPI assigned
- Jun 24, 2015
- Last updated
- Jun 24, 2015
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Contractor | 171W00000X | NU | Primary |
Addresses
Primary practice location
2300 Seaman St
Apt. 101
Toledo, OH 43605-1952
Mailing address
2300 Seaman St
Apt. 101
Toledo, OH 43605-1952
Phone (419) 810-2055
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": "1435104000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1435104000000",
"number": "1407238660",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2300 SEAMAN ST",
"address_2": "APT. 101",
"city": "TOLEDO",
"state": "OH",
"postal_code": "436051952",
"telephone_number": "419-810-2055"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2300 SEAMAN ST",
"address_2": "APT. 101",
"city": "TOLEDO",
"state": "OH",
"postal_code": "436051952",
"telephone_number": "419-810-2055"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "ANDREA",
"name_prefix": "Ms.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-06-24",
"last_updated": "2015-06-24",
"status": "A"
},
"taxonomies": [
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Toledo, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.