Provider Demographics
NPI:1003814161
Name:CLARKE A. MCKINNEY
Entity Type:Organization
Organization Name:CLARKE A. MCKINNEY
Other - Org Name:FREEDOM CARS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLARKE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCKINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-429-6323
Mailing Address - Street 1:4711 CLARK AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-3268
Mailing Address - Country:US
Mailing Address - Phone:651-429-6323
Mailing Address - Fax:651-426-2046
Practice Address - Street 1:4711 CLARK AVE
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-3268
Practice Address - Country:US
Practice Address - Phone:651-429-6323
Practice Address - Fax:651-426-2046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies