Healthcare Provider Details

I. General information

NPI: 1952075111
Provider Name (Legal Business Name): THE CLARK GROUP ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2021
Last Update Date: 08/02/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3831 E COUNTY ROAD 400 S
MIDDLETOWN IN
47356-9505
US

IV. Provider business mailing address

PO BOX 214
PENDLETON IN
46064-0214
US

V. Phone/Fax

Practice location:
  • Phone: 317-402-2753
  • Fax: 877-402-9441
Mailing address:
  • Phone: 317-402-7523
  • Fax: 877-402-9441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. CLARK E. SIMPSON
Title or Position: PRESIDENT/CEO
Credential: MBA, MED, RKT, LAT
Phone: 317-402-2753