MEDICARE: CLARK AND ASSOCIATES, INC

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	332B00000X	Durable Medical Equipment & Medical Supplies
2	335E00000X	Prosthetic/Orthotic Supplier		IA

General Provider Information

NPI Number	:	1578919593
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLARK AND ASSOCIATES, INC

Provider Business Mailing Address
First Line	:	PO BOX 650846
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75265-0846
Country	:	US
Telephone Number	:	712-224-2378
Fax Number	:	712-224-2379

Provider Business Practice Location Address
First Line	:	4301 SERGEANT RD
Second Line	:	#105
City	:	SIOUX CITY
State	:	IA
Zip	:	51106-4726
Country	:	US
Telephone Number	:	712-224-2378
Fax Number	:	712-224-2379

Authorized Official
Title or Position	:	REGULATORY COMPLIANCE ANALYST III
Name	:	JENNIFER L SIMMONS
Credential	:
Telephone Number	:	206-414-2907

Provider Enumeration Date	:	05/09/2016
Last Update Date	:	05/18/2026

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