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General NPI Number Information
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NPI Number | 1073808721
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Entity Type | Individual
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Provider Name | JOSHUA GLEN CLEMENTS RSA
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Gender | Male
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Dates
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Enumeration Date | 06/10/2011
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Last Update Date | 04/05/2013
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Provider Practice Location Address
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Address Line | 10039 BISSONNET ST STE 250
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City | HOUSTON
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State | TX
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Zip | 77036-7852
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Country | US
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Telephone | 815-545-7750
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Fax |
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Provider Business Mailing Address
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Address Line | 30907 CORRECT CRAFT LN
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City | WILMINGTON
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State | IL
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Zip | 60481-2147
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Country | US
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Telephone | 815-545-7750
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | 238.000287
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 246ZS0410X
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Taxonomy Name | Surgical Technologist
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License Number | 238.000287
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 238.000287
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License Number State | IL
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