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General NPI Number Information
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NPI Number | 1255782546
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Entity Type | Organization
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Legal Business Name | CLARKSON HEALTH LLC
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Dates
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Enumeration Date | 06/28/2016
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Last Update Date | 09/25/2016
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Provider Practice Location Address
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Address Line | 4821 OLD NATIONAL RD E SUITE A
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City | RICHMOND
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State | IN
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Zip | 47374-2651
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Country | US
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Telephone | 765-373-3910
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Fax | 800-569-1924
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Provider Business Mailing Address
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Address Line | 2087 E KITCHEL RD 2087 EAST KITCHEL ROAD
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City | LIBERTY
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State | IN
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Zip | 47353-9295
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Country | US
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Telephone | 765-969-0052
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Fax | 800-569-1924
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. JOHN B CLARKSON
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Credential | M.D.
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Telephone | 765-969-0052
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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