Organization
PENNYRILE RADIOLOGY, PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES M CLARK MD (OWNER/PARTNER)
(270) 885-3414
Entity
Organization
Contact information
Practice address
215 W 17TH ST, HOPKINSVILLE, KY 42240-1911
(270) 885-3414
(270) 885-7631
Mailing address
PO BOX 595, HOPKINSVILLE, KY 42241-0595
(270) 885-3414
(270) 885-7631
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000057622
ANTHEM
KY
05
—
65901829
—
KY
Enumeration date
07/05/2006
Last updated
04/20/2008
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