# CLARK MEMORIAL HOSPITAL

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Primary Care Services
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629015953
- **Authorized official:** MR. KIRK WILLIAM STRACK (VICE PRESIDENT FINANCE CFO)
- **Authorized official phone:** (812) 283-2488

## Contact information

- **Practice address:** 1806 E 10TH ST, JEFFERSONVILLE, IN 47130
- **Practice address phone:** (812) 285-5926
- **Practice address fax:** (812) 280-5723
- **Mailing address:** 1806 E 10TH ST, JEFFERSONVILLE, IN 47130
- **Mailing address phone:** (812) 285-5926
- **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 | — | — | — |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | — |
| 207X00000X | Orthopaedic Surgery Physician | — | — | — |
| 208000000X | Pediatrics Physician | — | NULL | — |
| 208000000X | Pediatrics Physician | — | — | — |

## Other

- **Enumeration date:** 06/02/2006
- **Last updated:** 07/31/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100074370 | — | IN |
| 01 | — | CD6896 | RAILROAD MEDICARE GROUP | — |
| 01 | — | CI1990 | RAILROAD MEDICARE GROUP | — |