Daryl Clark

Primary specialty

ContractorTaxonomy code 171W00000X

Practice address

13 Surrey CT Ste 200
Columbia, SC 29212-3172

Phone

(803) 553-5965

Fax

(803) 451-0328

NPI assigned

Oct 6, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• M.a.P. II Transport LLC

  • Ambulance
  • Columbia, SC
  • NPI 1083422455
  NPD Authorized official

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

{
    "created_epoch": "1601942400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601942400000",
    "number": "1629675236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13 SURREY CT STE 200",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292123172",
            "telephone_number": "803-553-5965",
            "fax_number": "803-451-0328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13 SURREY CT STE 200",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292123172",
            "telephone_number": "803-553-5965",
            "fax_number": "803-451-0328"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "DARYL",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-10-06",
        "last_updated": "2020-10-06",
        "certification_date": "2020-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171W00000X",
            "taxonomy_group": "",
            "desc": "Contractor",
            "state": "SC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "m.a.p.transport2019@gmail.com",
            "affiliation": "N",
            "endpointDescription": "Email address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "13 Surrey Ct Ste 200",
            "city": "Columbia",
            "state": "SC",
            "country_code": "US",
            "postal_code": "292123172",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Annette Renae Clark-Brown, M.D.
• Alexis Kristine Clark, MD
• Amanda K Clark, RRT
• Amanda S Clark, FNP
• Antoinette Clark
• Dawn M. Clark, CRNA
• Deborah A Clark, LPC
• Demetria Godfrey Clark
• Derek Clark, DPT
• Elijah Clark

• Contractor in Columbia, SC
• Providers in Columbia, SC by specialty
• Contractor in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 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.