Provider Demographics
NPI:1265852529
Name:CLARK STEERE PRODUCTIONS LLC
Entity Type:Organization
Organization Name:CLARK STEERE PRODUCTIONS LLC
Other - Org Name:THE CLARK CLINIC FOR ADULT HEALTHCARE & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RANDOLPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-860-0935
Mailing Address - Street 1:8776 E SHEA BLVD
Mailing Address - Street 2:SUITE 106-430
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6629
Mailing Address - Country:US
Mailing Address - Phone:480-860-0935
Mailing Address - Fax:480-860-6569
Practice Address - Street 1:8560 E SHEA BLVD
Practice Address - Street 2:SUITE #130
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6679
Practice Address - Country:US
Practice Address - Phone:480-860-0935
Practice Address - Fax:480-860-6569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-24
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty