Provider Demographics
NPI:1578510186
Name:CLEM'S MEDICAL, LLC
Entity Type:Organization
Organization Name:CLEM'S MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:CLEM
Authorized Official - Suffix:I
Authorized Official - Credentials:RN
Authorized Official - Phone:580-256-7006
Mailing Address - Street 1:1108 TEXAS ST
Mailing Address - Street 2:
Mailing Address - City:WOODWARD
Mailing Address - State:OK
Mailing Address - Zip Code:73801-3130
Mailing Address - Country:US
Mailing Address - Phone:580-256-7006
Mailing Address - Fax:580-256-7513
Practice Address - Street 1:1108 TEXAS ST
Practice Address - Street 2:
Practice Address - City:WOODWARD
Practice Address - State:OK
Practice Address - Zip Code:73801-3130
Practice Address - Country:US
Practice Address - Phone:580-256-7006
Practice Address - Fax:580-256-7513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK5104020001Medicare ID - Type Unspecified