Provider Demographics
NPI:1437169935
Name:CLARE MEDICAL INC
Entity Type:Organization
Organization Name:CLARE MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ALTERNATE CHANNELS MGR.
Authorized Official - Prefix:MRS
Authorized Official - First Name:TANISHA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-221-0900
Mailing Address - Street 1:3220 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-3318
Mailing Address - Country:US
Mailing Address - Phone:757-397-4560
Mailing Address - Fax:757-397-0277
Practice Address - Street 1:3220 HIGH ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707-3318
Practice Address - Country:US
Practice Address - Phone:757-397-4560
Practice Address - Fax:757-397-0277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009135707Medicaid
VA009135707Medicaid
VA0215650001Medicare PIN