D. Scott Clark,M.D.,Inc. – Surgery Physician

Key facts

NPI: 1922155779
Entity type: Organization (NPI type 2)
Primary specialty: Surgery Physician 208600000X
License: C27196 (CA)
Legal business name: D. SCOTT CLARK,M.D.,INC.
Practice address: 152 Pioneer LN
Bishop, CA 93514-2563
Phone: (760) 872-2244
NPI assigned: Jan 4, 2007
Organization subpart: No

Authorized official

Name: D. Scott Clark, M.D.
Title: Pres.
Phone: (760) 872-2244

National Provider Directory

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Surgery Physician Group: 193400000X SINGLE SPECIALTY GROUP	208600000X	C27196	CA	Yes

Addresses

Primary practice location

152 Pioneer LN
Bishop, CA 93514-2563

Mailing address

152 Pioneer LN
Bishop, CA 93514-2563
Phone (760) 872-2244

Other identifiers

Identifier	Type	State	Issuer
00C271960	Medicaid	CA

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 8, 2008.

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202428800000",
    "number": "1922155779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "152 PIONEER LN",
            "city": "BISHOP",
            "state": "CA",
            "postal_code": "935142563",
            "telephone_number": "760-872-2244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "152 PIONEER LN",
            "city": "BISHOP",
            "state": "CA",
            "postal_code": "935142563",
            "telephone_number": "760-872-2244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "D. SCOTT CLARK,M.D.,INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-04",
        "last_updated": "2008-02-08",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "D.",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "PRES.",
        "authorized_official_telephone_number": "760-872-2244",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "CA",
            "license": "C27196",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00C271960",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bishop, CA

All providers in Bishop, CA · Surgery Physician in California

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 8, 2008. 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.

Verify at the official NPI Registry.