# JASON H CLARK & SANDRA J CLARK

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912185927
- **Authorized official:** JASON CLARK (OWNER)
- **Authorized official phone:** (662) 514-5215

## Contact information

- **Practice address:** 139 COUNTY ROAD 379, WATER VALLEY, MS 38965-3607
- **Practice address phone:** (662) 514-5215
- **Practice address fax:** (662) 234-0172
- **Mailing address:** PO BOX 994, OXFORD, MS 38655-0994
- **Mailing address phone:** (662) 514-5215
- **Mailing address fax:** (662) 234-0172

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 335V00000X | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | MRT2279 | MS | Yes |

## Other

- **Enumeration date:** 02/01/2008
- **Last updated:** 12/03/2008