Megan Clark
Individual provider Active NPI Private Vehicle · Lebanon, IN
NPI 1841732997 · NPPES record last updated Nov 7, 2016
Key facts
- NPI
- 1841732997
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Private Vehicle 347C00000X
- License
- 0340308057 (IN)
- Practice address
- 224 N East St
Lebanon, IN 46052-2224 - Phone
- (765) 894-7982
- NPI assigned
- Nov 7, 2016
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0340308057 | IN | MD | Private Vehicle |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Private Vehicle | 347C00000X | 0340308057 | IN | Yes |
Addresses
Primary practice location
224 N East St
Lebanon, IN 46052-2224
Mailing address
224 N East St
Lebanon, IN 46052-2224
Phone (765) 894-7982
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 105626973999 | Medicaid | IN | |
| 105626974799 | Medicaid | IN |
Other providers in Lebanon, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 7, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.