Healthcare Provider Details

I. General information

NPI: 1033190137
Provider Name (Legal Business Name): CLOCK MEDICAL SUPPLY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 01/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 INDUSTRIAL BLVD
WINFIELD KS
67156-9129
US

IV. Provider business mailing address

PO BOX 620
WINFIELD KS
67156-0620
US

V. Phone/Fax

Practice location:
  • Phone: 620-221-0550
  • Fax: 620-221-7460
Mailing address:
  • Phone: 620-221-0550
  • Fax: 620-221-7460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT L CLOCK
Title or Position: PRESIDENT
Credential:
Phone: 620-221-0550