Healthcare Provider Details

I. General information

NPI: 1558863852
Provider Name (Legal Business Name): CLARKSDALE REGIONAL PHYSICIANS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2018
Last Update Date: 03/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1970 HOSPITAL DR
CLARKSDALE MS
38614-7202
US

IV. Provider business mailing address

1721 MIDPARK RD
KNOXVILLE TN
37921-5977
US

V. Phone/Fax

Practice location:
  • Phone: 662-621-5019
  • Fax:
Mailing address:
  • Phone: 865-269-4074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: STEVE CLAPP
Title or Position: PRESIDENT
Credential:
Phone: 865-269-4074