Clark Clinic, Inc

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

License

03575 Issued in MS

Legal business name

CLARK CLINIC, INC

Practice address

36 Second St
Morton, MS 39117-3424

Phone

(601) 732-8612

Fax

(601) 732-1957

NPI assigned

Jul 13, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Howard D Clark, MD

Title

Medical Director

Phone

(601) 732-8612

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1200268800000",
    "number": "1982629705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36 SECOND ST",
            "city": "MORTON",
            "state": "MS",
            "postal_code": "391173424",
            "telephone_number": "601-732-8612",
            "fax_number": "601-732-1957"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36 SECOND ST",
            "city": "MORTON",
            "state": "MS",
            "postal_code": "391173424",
            "telephone_number": "601-732-8612",
            "fax_number": "601-732-1957"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARK CLINIC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-13",
        "last_updated": "2008-01-14",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "HOWARD",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "601-732-8612",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "MS",
            "license": "03575",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09014545",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Morton, MS
• Rural Health Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2008; 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.