Organization
NORTH CLARK MEDICAL GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUHAS GANDHI (AUTHORIZED OFFICIAL)
(502) 244-9859
Entity
Organization
Contact information
Practice address
1802 E 10TH ST, JEFFERSONVILLE, IN 47130-6016
(812) 288-2488
(812) 288-6603
Mailing address
2100 MARKET ST STE 101, CHARLESTOWN, IN 47111-9535
(812) 503-5100
(770) 573-9513
Taxonomy
Speciality
Code
Description
License number
State
207RA0401X
Addiction Medicine (Internal Medicine) Physician
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
—
208600000X
Surgery Physician
—
—
208D00000X
General Practice Physician
Primary
—
—
208VP0014X
Interventional Pain Medicine Physician
—
—
251B00000X
Case Management Agency
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
261QM2800X
Methadone Clinic
—
—
261QP2300X
Primary Care Clinic/Center
—
—
261QU0200X
Urgent Care Clinic/Center
—
—
291U00000X
Clinical Medical Laboratory
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300010664
—
IN
05
—
7100535740
—
KY
01
—
IN3604
MEDICARE IN
IN
01
—
K258180
MEDICARE KY
KY
Enumeration date
11/02/2016
Last updated
04/09/2026
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