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1376095711

NPI Code Detail

MEDICARE: NORTH CLARK MEDICAL GROUP LLC

MEDICARE: NORTH CLARK MEDICAL GROUP 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	261QP2300X	Primary Care Clinic/Center
2	261QM0850X	Adult Mental Health Clinic/Center
3	324500000X	Substance Abuse Rehabilitation Facility
4	291U00000X	Clinical Medical Laboratory
5	261QM2800X	Methadone Clinic
6	208VP0014X	Interventional Pain Medicine Physician
7	207RA0401X	Addiction Medicine (Internal Medicine) Physician
8	261QU0200X	Urgent Care Clinic/Center
9	367500000X	Certified Registered Nurse Anesthetist
10	2085R0202X	Diagnostic Radiology Physician
11	208600000X	Surgery Physician
12	261QM1300X	Multi-Specialty Clinic/Center
13	251B00000X	Case Management Agency
14	207RC0000X	Cardiovascular Disease Physician
15	208D00000X	General Practice Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	K258180	OTHER	KY	MEDICARE KY
4	IN3604	OTHER	IN	MEDICARE IN

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376095711
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH CLARK MEDICAL GROUP LLC

Provider Business Mailing Address
First Line	:	2100 MARKET ST STE 101
Second Line	:
City	:	CHARLESTOWN
State	:	IN
Zip	:	47111-9535
Country	:	US
Telephone Number	:	812-503-5100
Fax Number	:	770-573-9513

Provider Business Practice Location Address
First Line	:	1802 E 10TH ST
Second Line	:
City	:	JEFFERSONVILLE
State	:	IN
Zip	:	47130-6016
Country	:	US
Telephone Number	:	812-288-2488
Fax Number	:	812-288-6603

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	SUHAS GANDHI
Credential	:
Telephone Number	:	502-244-9859

Provider Enumeration Date	:	11/02/2016
Last Update Date	:	04/09/2026

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Directions to “NORTH CLARK MEDICAL GROUP LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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