Provider Demographics
NPI:1588799456
Name:CLARK HOME RESPIRATORY SUPPLY INC
Entity Type:Organization
Organization Name:CLARK HOME RESPIRATORY SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:518-943-3456
Mailing Address - Street 1:168 JEFFERSON HEIGHTS
Mailing Address - Street 2:
Mailing Address - City:CATSKILL
Mailing Address - State:NM
Mailing Address - Zip Code:12414
Mailing Address - Country:US
Mailing Address - Phone:518-943-3456
Mailing Address - Fax:518-943-2053
Practice Address - Street 1:181 NORTH RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:NY
Practice Address - Zip Code:12528-1029
Practice Address - Country:US
Practice Address - Phone:845-691-7383
Practice Address - Fax:518-943-2053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0131550002Medicare NSC