NORTH CLARK MEDICAL GROUP LLC NPI 1376095711

NPI Information

NPI: 1376095711
Provider Name: NORTH CLARK MEDICAL GROUP LLC
Classification: General Practice - 208D00000X
Entity Type: Organization

CLIA Number: 15D2268132

Address:
1802 E 10TH ST
JEFFERSONVILLE, IN
ZIP 47130
Phone: (812) 288-2488
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NORTH CLARK MEDICAL GROUP LLC is a general practice in Jeffersonville, IN. The provider is a physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee NORTH CLARK MEDICAL GROUP LLC NPI is 1376095711. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

1802 E 10TH ST
JEFFERSONVILLE, IN
ZIP 47130-016
Phone: (812) 288-2488
Fax: (812) 288-6603

The provider's authorized official is Joseph Nalley .
The authorized official title is Ceo and has the following contact phone number (502) 244-9859.

The CLIA number assigned to this NPI record is 15D2268132 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/2/2016 and was last updated on 3/21/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	207RA0401X	Internal Medicine	Addiction Medicine	No
2	2085R0202X	Radiology	Diagnostic Radiology	No
3	208600000X	Surgery		No
4	208D00000X	General Practice		Yes
5	208VP0014X	Pain Medicine	Interventional Pain Medicine	No
6	251B00000X	Case Management		No
7	261QM0850X	Clinic/Center	Adult Mental Health	No
8	261QM0855X	Clinic/Center	Adolescent and Children Mental Health	No
9	261QM1300X	Clinic/Center	Multi-Specialty	No
10	261QM2800X	Clinic/Center	Methadone	No
11	261QP2300X	Clinic/Center	Primary Care	No
12	261QU0200X	Clinic/Center	Urgent Care	No
13	291U00000X	Clinical Medical Laboratory		No
14	324500000X	Substance Abuse Rehabilitation Facility		No
15	367500000X	Nurse Anesthetist, Certified Registered		No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	300010664	MEDICAID	INDIANA
2	7100535740	MEDICAID	KENTUCKY
3	IN3604	OTHER	INDIANA	MEDICARE IN
4	K258180	OTHER	KENTUCKY	MEDICARE KY

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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