Provider Demographics
NPI:1629336623
Name:ANIMAL CLINIC OF NORTH CLARKSVILLE
Entity Type:Organization
Organization Name:ANIMAL CLINIC OF NORTH CLARKSVILLE
Other - Org Name:ST. BETHLEHEM ANIMAL CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:VETERINARIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:WHITFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DVM
Authorized Official - Phone:931-645-4111
Mailing Address - Street 1:120 KRAFT ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-3091
Mailing Address - Country:US
Mailing Address - Phone:931-648-8818
Mailing Address - Fax:
Practice Address - Street 1:120 KRAFT ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-3091
Practice Address - Country:US
Practice Address - Phone:931-648-8818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANIMAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1321174M00000X
TN1617174M00000X
TN3447174M00000X
TN5510174M00000X
TN3613174M00000X
TN5220174M00000X
TN5258174M00000X
TN3014174M00000X
TN5267174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174M00000XOther Service ProvidersVeterinarianGroup - Single Specialty