Provider Demographics
NPI:1336382431
Name:CLARKS HOME MEDICAL EQUIPMENT, INC
Entity Type:Organization
Organization Name:CLARKS HOME MEDICAL EQUIPMENT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STOTESBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-792-7841
Mailing Address - Street 1:505 WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTON
Mailing Address - State:NC
Mailing Address - Zip Code:27892-1441
Mailing Address - Country:US
Mailing Address - Phone:252-792-7841
Mailing Address - Fax:252-789-8401
Practice Address - Street 1:505 WEST BLVD
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:NC
Practice Address - Zip Code:27892-1441
Practice Address - Country:US
Practice Address - Phone:252-792-7841
Practice Address - Fax:252-789-8401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-20
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC01495332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6234730001Medicare NSC