Provider Demographics
NPI:1740606847
Name:CLARK BUILDERS
Entity Type:Organization
Organization Name:CLARK BUILDERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:CONTRACTOR
Authorized Official - Phone:731-988-5304
Mailing Address - Street 1:860 BEAR CREEK RD
Mailing Address - Street 2:
Mailing Address - City:PINSON
Mailing Address - State:TN
Mailing Address - Zip Code:38366-1955
Mailing Address - Country:US
Mailing Address - Phone:731-988-5304
Mailing Address - Fax:731-425-2485
Practice Address - Street 1:860 BEAR CREEK RD
Practice Address - Street 2:
Practice Address - City:PINSON
Practice Address - State:TN
Practice Address - Zip Code:38366-1955
Practice Address - Country:US
Practice Address - Phone:731-988-5304
Practice Address - Fax:731-425-2485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-13
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00054804251F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN039920964OtherTENNESSEE DRIVERS LICENSE
TN00054804OtherSTATE OF TENNESSEE CONTRACTOR