LOWELL F. CLARK MD PA (NPI# 1629278882) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629278882 |
| Entity Type | Organization |
| Organization Name | LOWELL F. CLARK MD PA |
| Practice Address |
212 S Florida St Bushnell FL 33513-6703 |
| Practice Telephone | 3527871600 |
| Practice Fax Number | 3527933282 |
| Mailing Telephone | 3527871600 |
| Mailing Fax Number | 3527933282 |
| Enumeration Date | 2007-07-24 |
| Last Update Date | 2007-12-21 |
| Authorized Official Name | DR. ELIZABETH E FOLK (PRESIDENT) |
| Authorized Official Telephone | 3527871600 |
| Authorized Official Credential | ED.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | ME45090 | FL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | BCBS OF FLORIDA GROUP ID | 33972 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326671256 | Lowell F. Clark Md Pa | Clinic/Center | 110 Lodge Terrace Dr, Altoona, FL 32702-9668 | 2020-02-19 |
| 1144853078 | Lowell F. Clark Md Pa | Clinic/Center | 31450 Church St, Sorrento, FL 32776-9594 | 2020-02-19 |
| Street Address |
212 S FLORIDA ST |
| City | BUSHNELL |
| State | FL |
| Zip Code | 33513-6703 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467441790 | Vijaya L Nagabhairu | Family Medicine | 212 S Florida St, Bushnell, FL 33513-6703 | 2005-10-19 |
| 1154893477 | Noelle Mooneyham | Nurse Practitioner | 212 S Florida St, Bushnell, FL 33513-6703 | 2018-12-27 |
| 1154804615 | Mary Hyacinth Bodenheimer | Nurse Practitioner | 212 S Florida St, Bushnell, FL 33513-6703 | 2018-09-11 |
| 1669897377 | Ronnie-jane Boekema | Registered Nurse | 212 S Florida St, Bushnell, FL 33513-6703 | 2014-03-04 |
| 1942648803 | Akram Youssef | Family Medicine | 212 S Florida St, Bushnell, FL 33513-6703 | 2013-06-12 |
| 1740531011 | Daniel D Dstteffano | General Practice | 212 S Florida St, Clark Clinic Inc, Bushnell, FL 33513-6703 | 2012-09-27 |
| 1306108022 | Yanira Isbet Lara | Family Medicine | 212 S Florida St, Bushnell, FL 33513-6703 | 2012-06-08 |
| 1992029748 | Victoria A Edelman | Nurse Practitioner | 212 S Florida St, Bushnell, FL 33513-6703 | 2010-03-23 |
| 1255518486 | Ehrentraud Johanna Eichelbaum | General Practice | 212 S Florida St, Bushnell, FL 33513-6703 | 2008-01-30 |
| 1376733857 | Clark Clinic Inc | Clinic/Center | 212 S Florida St, Bushnell, FL 33513-6703 | 2007-07-31 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619465481 | Crystal Wallace Goddin | Physical Therapy Assistant | 1104 N Main St, Bushnell, Fl, Bushnell, FL 33513 | 2018-04-27 |
| 1255836920 | Anton Dawson | Behavior Technician | 2310 Cr 615, Bushnell, FL 33513 | 2018-03-26 |
| 1942728431 | Carolyn Sue Guarino | Licensed Practical Nurse | 10306 S.w. 53rd Terr., Bushnell, FL 33513 | 2017-09-05 |
| 1326321258 | Edith Marie Evans | Case Manager/Care Coordinator | 2891 C.r. 615b, Bushnell, FL 33513 | 2011-09-27 |
| 1144478439 | Emma J Ridley | Pharmacist | Sumter Oaks Park, 4602 Couny Rd. 673, #14107, Bushnell, FL 33513 | 2008-08-29 |
| 1205083268 | Diana K Mullin | Day Training, Developmentally Disabled Services | 9325 Cr 622 G, Bushnell, FL 33513 | 2008-08-21 |
| 1467625202 | Amy's Caring Hands | Day Training, Developmentally Disabled Services | 1612 W County Road 476, Bushnell, FL 33513 | 2008-04-11 |
| 1821212952 | Stuart J Kaufman Md & Assoc Pa | Ophthalmology | 1814 West Cr 48, Bushnell, FL 33513 | 2007-04-12 |
| 1740201128 | Winn Dixie Stores Inc | Durable Medical Equipment & Medical Supplies | 1122 N Main St, Bushnell, FL 33513 | 2006-07-21 |
| 1184688947 | Florida Department of Health | Public Health or Welfare | 415 E Noble Ave, Bushnell, FL 33513 | 2006-04-17 |
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| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659322089 | Ramon A Perez | Internal Medicine | 212 S Florida St, Bushnell, FL 33513-6703 | 2006-05-12 |
| 1336103563 | Lowell F. Clark | Internal Medicine | 212 S Florida St, Bushnell, FL 33513-6703 | 2006-04-14 |
| 1619976198 | Mahmud U Ahmed | Internal Medicine | 117 W Belt Ave, Suite A, Bushnell, FL 33513-5105 | 2005-07-18 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.