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Organization
CLARK PHYSICIAN GROUP LLC
Active
Organization
CLARK PHYSICIAN GROUP LLC
Active
Parent organization
CLARK MEMORIAL HOSPITAL
Organization subpart
Yes
Provider details
NPI number
Legal business name
CLARK MEMORIAL HOSPITAL
Authorized official
MR. KIRK WILLIAM STRACK (CFO)
(812) 283-2488
Entity
Organization
Contact information
Practice address
1806 E 10TH ST, JEFFERSONVILLE, IN 47130-6016
(812) 285-5983
(812) 280-5723
Mailing address
1806 E 10TH ST, JEFFERSONVILLE, IN 47130-6016
(812) 285-5983
(812) 280-5723
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
207RC0000X
Cardiovascular Disease Physician
—
NULL
207RC0000X
Cardiovascular Disease Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
NULL
207V00000X
Obstetrics & Gynecology Physician
—
—
207VG0400X
Gynecology Physician
—
NULL
207VG0400X
Gynecology Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
NULL
207X00000X
Orthopaedic Surgery Physician
—
—
208000000X
Pediatrics Physician
—
NULL
208000000X
Pediatrics Physician
—
—
363A00000X
Physician Assistant
—
NULL
363A00000X
Physician Assistant
—
—
363LA2200X
Adult Health Nurse Practitioner
—
NULL
363LA2200X
Adult Health Nurse Practitioner
—
—
363LP0200X
Pediatric Nurse Practitioner
—
NULL
363LP0200X
Pediatric Nurse Practitioner
—
—
363LW0102X
Women's Health Nurse Practitioner
—
NULL
363LW0102X
Women's Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100074370
—
IN
Enumeration date
07/31/2008
Last updated
03/25/2013
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