Provider Demographics
NPI:1891839874
Name:CLARK MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:CLARK MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCE AND CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:STRACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-283-2448
Mailing Address - Street 1:1220 MISSOURI AVE
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3725
Mailing Address - Country:US
Mailing Address - Phone:812-282-6631
Mailing Address - Fax:812-283-2688
Practice Address - Street 1:1220 MISSOURI AVE
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3725
Practice Address - Country:US
Practice Address - Phone:812-282-6631
Practice Address - Fax:812-283-2688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN15-S009Medicare Oscar/Certification
IN15-0009Medicare Oscar/Certification
IN15-5314Medicare ID - Type UnspecifiedMEDICARE SUBACUTE