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General NPI Number Information
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NPI Number | 1902323009
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Entity Type | Organization
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Legal Business Name | NORTON CLARK PHYSICIAN PRACTICES, LLC
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Dates
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Enumeration Date | 08/29/2017
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Last Update Date | 11/07/2023
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Provider Practice Location Address
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Address Line | 2021 MERCY WAY STE 102
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City | JEFFERSONVILLE
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State | IN
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Zip | 47130
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Country | US
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Telephone | 812-252-0258
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Fax | 812-252-0315
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Provider Business Mailing Address
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Address Line | 4803 OLYMPIA PARK PLZ STE 1100
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City | LOUISVILLE
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State | KY
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Zip | 40241-3009
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VP MANAGED CARE
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Name | SHELLEY GAST
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Credential |
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Telephone | 502-272-5335
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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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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