Provider Demographics
NPI:1245414192
Name:CLARK SPRINGS, MD, LLC
Entity Type:Organization
Organization Name:CLARK SPRINGS, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SPRINGS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-274-1034
Mailing Address - Street 1:550 UNIVERSITY BLVD
Mailing Address - Street 2:SUITE 3080
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5149
Mailing Address - Country:US
Mailing Address - Phone:317-274-1034
Mailing Address - Fax:317-274-3265
Practice Address - Street 1:550 UNIVERSITY BLVD
Practice Address - Street 2:SUITE 3080
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5149
Practice Address - Country:US
Practice Address - Phone:317-274-8937
Practice Address - Fax:317-274-2727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN221320Medicare PIN