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General NPI Number Information
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NPI Number | 1740606847
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Entity Type | Organization
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Legal Business Name | CLARK BUILDERS
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Dates
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Enumeration Date | 03/13/2014
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Last Update Date | 03/13/2014
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Provider Practice Location Address
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Address Line | 860 BEAR CREEK RD
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City | PINSON
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State | TN
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Zip | 38366-1955
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Country | US
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Telephone | 731-988-5304
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Fax | 731-425-2485
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Provider Business Mailing Address
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Address Line | 860 BEAR CREEK RD
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City | PINSON
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State | TN
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Zip | 38366-1955
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Country | US
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Telephone | 731-988-5304
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Fax | 731-425-2485
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Authorized Official
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Title or Position | OWNER
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Name | MR. MICHAEL L CLARK
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Credential | CONTRACTOR
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Telephone | 731-988-5304
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251F00000X
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Taxonomy Name | Home Infusion Agency
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License Number | 00054804
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License Number State | TN
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