MEDICARE: CLERK AND SONS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)		MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063780872
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLERK AND SONS LLC

Provider Business Mailing Address
First Line	:	3204 DODIER ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63107-2603
Country	:	US
Telephone Number	:	314-346-8957
Fax Number	:	314-652-6394

Provider Business Practice Location Address
First Line	:	3204 DODIER ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63107-2603
Country	:	US
Telephone Number	:	314-346-8957
Fax Number	:	314-652-6394

Authorized Official
Title or Position	:	HUMAN RESOURCE DIRECTOR
Name	:	MS. KATRINA TOWNSEND
Credential	:
Telephone Number	:	314-346-8957

Provider Enumeration Date	:	12/07/2011
Last Update Date	:	12/07/2011

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Directions to “CLERK AND SONS LLC ” Practice Location

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