Provider Demographics
NPI:1710505128
Name:NORTH CLARK SURGERY CENTER LLC
Entity Type:Organization
Organization Name:NORTH CLARK SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:CREDENTIALING
Authorized Official - Phone:502-244-9859
Mailing Address - Street 1:1410 S CLARK BLVD STE 2100
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47129-3212
Mailing Address - Country:US
Mailing Address - Phone:502-244-9859
Mailing Address - Fax:770-573-9513
Practice Address - Street 1:2100 MARKET ST STE 200
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:IN
Practice Address - Zip Code:47111-8507
Practice Address - Country:US
Practice Address - Phone:812-503-5100
Practice Address - Fax:770-573-9513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty