Provider Demographics
NPI:1255782546
Name:CLARKSON HEALTH LLC
Entity type:Organization
Organization Name:CLARKSON HEALTH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:CLARKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-969-0052
Mailing Address - Street 1:2087 E KITCHEL RD
Mailing Address - Street 2:2087 EAST KITCHEL ROAD
Mailing Address - City:LIBERTY
Mailing Address - State:IN
Mailing Address - Zip Code:47353-9295
Mailing Address - Country:US
Mailing Address - Phone:765-969-0052
Mailing Address - Fax:800-569-1924
Practice Address - Street 1:4821 OLD NATIONAL RD E
Practice Address - Street 2:SUITE A
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-2651
Practice Address - Country:US
Practice Address - Phone:765-373-3910
Practice Address - Fax:800-569-1924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-28
Last Update Date:2016-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B29532Medicare UPIN