# CLARK PHYSICIAN GROUP LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** CLARK MEMORIAL HOSPITAL
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1396901104
- **Legal business name:** CLARK MEMORIAL HOSPITAL
- **Authorized official:** MR. KIRK WILLIAM STRACK (CFO)
- **Authorized official phone:** (812) 283-2488

## Contact information

- **Practice address:** 1806 E 10TH ST, JEFFERSONVILLE, IN 47130-6016
- **Practice address phone:** (812) 285-5983
- **Practice address fax:** (812) 280-5723
- **Mailing address:** 1806 E 10TH ST, JEFFERSONVILLE, IN 47130-6016
- **Mailing address phone:** (812) 285-5983
- **Mailing address fax:** (812) 280-5723

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 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

- **Enumeration date:** 07/31/2008
- **Last updated:** 03/25/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100074370 | — | IN |