Clinic652 LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

CLINIC652 LLC

Practice address

2600 E Meighan Blvd
Gadsden, AL 35903-1924

Phone

(256) 418-4005

Fax

(256) 399-0102

NPI assigned

Jan 25, 2022

Organization subpart

No

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

Authorized official

Name

Warren Alexander O'Meara-Dates

Title

Member/Chief Executive Officer

Phone

(256) 418-4005

Specialties & licenses 1

Addresses

Electronic endpoints 2

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/25513/brand/1/csg/1/fhir/r4

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

{
    "created_epoch": "1643068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643068800000",
    "number": "1508518002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "417 TAYLOR ST",
            "city": "GADSDEN",
            "state": "AL",
            "postal_code": "359032557"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 E MEIGHAN BLVD",
            "city": "GADSDEN",
            "state": "AL",
            "postal_code": "359031924",
            "telephone_number": "256-418-4005",
            "fax_number": "256-399-0102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINIC652 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-25",
        "last_updated": "2022-01-25",
        "certification_date": "2022-01-25",
        "status": "A",
        "authorized_official_last_name": "O'MEARA-DATES",
        "authorized_official_first_name": "WARREN",
        "authorized_official_middle_name": "ALEXANDER",
        "authorized_official_title_or_position": "MEMBER/CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "256-418-4005"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "warren@warrendates.com",
            "affiliation": "N",
            "endpointDescription": "Work Email Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "417 Taylor St",
            "city": "Gadsden",
            "state": "AL",
            "country_code": "US",
            "postal_code": "359032557",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "warren@warrendates.com",
            "affiliation": "N",
            "endpointDescription": "Work Email Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2600 E Meighan Blvd",
            "city": "Gadsden",
            "state": "AL",
            "country_code": "US",
            "postal_code": "359031924",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Ronald B Clark, CRNA
• Selena Nicole Christine Clark, ALC
• Callie Clement, NP
• Jimmy Lee Cline, PA-C
• Clinic of Gadsden, PC
• Clinical Urology Associates, P.C.
• Clokey Endodontics, LLC
• Clokey Family Eye Care PLLC
• David Clokey III, OD
• Judy Taylor Clontz, MS

• All providers in Gadsden, AL
• Internal Medicine Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2022; 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.