Provider Demographics
NPI:1033190137
Name:CLOCK MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:CLOCK MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:CLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-221-0550
Mailing Address - Street 1:PO BOX 620
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:KS
Mailing Address - Zip Code:67156-0620
Mailing Address - Country:US
Mailing Address - Phone:620-221-0550
Mailing Address - Fax:620-221-7460
Practice Address - Street 1:901 INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:KS
Practice Address - Zip Code:67156-9129
Practice Address - Country:US
Practice Address - Phone:620-221-0550
Practice Address - Fax:620-221-7460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-07
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0173700001Medicare NSC