Provider Demographics
NPI:1609389832
Name:CLARK, JAMES THOMAS (DME)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:THOMAS
Last Name:CLARK
Suffix:
Gender:M
Credentials:DME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11460 OLD MILL ROAD
Mailing Address - Street 2:PO BOX 294
Mailing Address - City:SPENCER
Mailing Address - State:OH
Mailing Address - Zip Code:44275
Mailing Address - Country:US
Mailing Address - Phone:330-648-1515
Mailing Address - Fax:
Practice Address - Street 1:11460 OLD MILL RD
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:OH
Practice Address - Zip Code:44275-9582
Practice Address - Country:US
Practice Address - Phone:330-648-1515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications