Organization
CLARK CLINIC, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HOWARD D CLARK MD (MEDICAL DIRECTOR)
(601) 732-8612
Entity
Organization
Contact information
Practice address
36 SECOND ST, MORTON, MS 39117-3424
(601) 732-8612
(601) 732-1957
Mailing address
36 SECOND ST, MORTON, MS 39117-3424
(601) 732-8612
(601) 732-1957
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
03575
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09014545
—
MS
Enumeration date
07/13/2006
Last updated
01/14/2008
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