Healthcare Provider Details

I. General information

NPI: 1780062810
Provider Name (Legal Business Name): CLARK AND ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2015
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12655 UNIVERSITY AVE #160
CLIVE IA
50325-8221
US

IV. Provider business mailing address

PO BOX 650846
DALLAS TX
75265-0846
US

V. Phone/Fax

Practice location:
  • Phone: 515-223-2344
  • Fax: 515-223-2322
Mailing address:
  • Phone: 515-223-2344
  • Fax: 515-223-2322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER L SIMMONS
Title or Position: REGULATORY COMPLIANCE ANALYST III
Credential:
Phone: 206-414-2907