Healthcare Provider Details

I. General information

NPI: 1326979790
Provider Name (Legal Business Name): RICARDO CLARK PRS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5760 PATRIOT BLVD
AUSTINTOWN OH
44515-1170
US

IV. Provider business mailing address

5760 PATRIOT BLVD
AUSTINTOWN OH
44515-1170
US

V. Phone/Fax

Practice location:
  • Phone: 330-953-0243
  • Fax: 330-953-3191
Mailing address:
  • Phone: 330-953-0243
  • Fax: 330-953-3191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberPRS.007704
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: