Healthcare Provider Details

I. General information

NPI: 1225806888
Provider Name (Legal Business Name): CLARKS MEDICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2023
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1946 42ND ST NE
CEDAR RAPIDS IA
52402-3041
US

IV. Provider business mailing address

1946 42ND ST NE
CEDAR RAPIDS IA
52402-3041
US

V. Phone/Fax

Practice location:
  • Phone: 319-200-4266
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number StateNULL

VIII. Authorized Official

Name: CRAIG CLARK
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 319-200-4266