MEDICARE: MARK S CLEM PA-C

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	363A00000X	Physician Assistant	110001634	VA
2	363AS0400X	Surgical Physician Assistant	PA1617	TN

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	:	1417942657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK S CLEM PA-C

Provider Business Mailing Address
First Line	:	304 WRIGHT ST
Second Line	:	SUITE 200
City	:	SWEETWATER
State	:	TN
Zip	:	37874-1181
Country	:	US
Telephone Number	:	865-632-5900
Fax Number	:	865-546-5227

Provider Business Practice Location Address
First Line	:	9125 CROSS PARK DR
Second Line	:	SUITE 200
City	:	KNOXVILLE
State	:	TN
Zip	:	37923-4505
Country	:	US
Telephone Number	:	865-632-5900
Fax Number	:	865-546-5227

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2005
Last Update Date	:	08/04/2016

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Directions to “ MARK S CLEM PA-C” Practice Location

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