HENRY VONDELL CLARK (NPI# 1790898450) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790898450 |
| Entity Type | Individual |
| Full Name | HENRY VONDELL CLARK |
| Credential | MD |
| Practice Address |
150 Fairview Road Ste 230 Mooreseville NC 28117 |
| Mailing Address |
Po Box 9 Attn Credentialing Kingsport TN 37662-0009 |
| Practice Telephone | 4233437018 |
| Mailing Telephone | 4238572093 |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2019-03-16 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 9800216 | NC | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | LICENSE - NC | 9800216 | 01 |
| NC | BCBS PROVIDER NUMBER | 11521 | 01 |
| NC | DEA - NC | BC5458624 | 01 |
| NC | 1790898450 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 19485 Old Jetton Rd, Suite 100, Cornelius, NC 280316582 | 7043841775 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235669037 | Henry William Clark | Counselor | 409 Vandiver West Bldg 6, Suite 102a, Great Circle, Columbia, MO 65202 | 2017-06-14 |
| 1467060905 | Henry Clark IIi | Pharmacist | 410 W 10th Ave, Columbus, OH 43210-1240 | 2020-07-21 |
| 1982253696 | Henry Larry Clark | Chore Provider | 550 W Pioneer Blvd Ste 204, Mesquite, NV 89027-1406 | 2019-09-05 |
| Street Address |
150 FAIRVIEW ROAD STE 230 |
| City | MOORESEVILLE |
| State | NC |
| Zip Code | 28117 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891356648 | Teleoptometric Service, P.C. | Optometrist | 392 Talbert Rd, Mooresville, NC 28117 | 2019-06-24 |
| 1992268544 | Costco Wholesale Corporation | Eyewear Supplier (Equipment, not the service) | 392 Talbert Rd., Mooresville, NC 28117 | 2019-04-10 |
| 1982178042 | Langtree Endoscopy Center, LLC | Clinic/Center | 106 Alexander Bank Drive, Suite 101, Mooresville, NC 28117 | 2019-01-11 |
| 1679044416 | May and Associates Therapy Center | Psychologist | 862 Brawley School Road, Suite 202, Mooresville, NC 28117 | 2018-12-05 |
| 1700360153 | Sabrina Chabot Hutchinson | Physical Therapist | 508 Williamson Rd, Suite 200, Mooresville, NC 28117 | 2018-09-21 |
| 1992284327 | Presbyterian Imaging Centers LLC | Radiology | 106 Langtree Village Dr # 201, Mooresville, NC 28117 | 2018-08-07 |
| 1073091310 | Jenelle Donzelli Nemeth | Registered Nurse | 102 Sapphire Drive, Mooresville, NC 28117 | 2018-07-30 |
| 1912497496 | Patsharx LLC | Pharmacy | 480 River Hwy, Suite A, Mooresville, NC 28117 | 2018-05-10 |
| 1427502434 | Counseling Service At Lake Norman, Pllc | Community/Behavioral Health | 18117 W. Catawba Avenue, Cornelius, NC 28117 | 2016-08-08 |
| 1447605928 | Renewal Counseling, Pllc | Counselor | 125 Commerce Park Rd., Suite 102, Mooresville, NC 28117 | 2016-05-03 |
| Find all providers in zip 28117 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710586581 | Fhpg, LLC | Family Medicine | 1690 Us Highway 1 S Ste 200, Southern Pines, NC 28387-7037 | 2020-10-22 |
| 1225637333 | Mcpc-8, LLC | Family Medicine | 3110 S Horner Blvd Ste 4&5, Sanford, NC 27332-8212 | 2020-10-20 |
| 1740889864 | Mcpc-8, LLC | Family Medicine | 1690 Us Highway 1 S Ste 100, Southern Pines, NC 28387-7037 | 2020-10-20 |
| 1851999882 | Integrative Wellness Partners, Inc | Family Medicine | 3555 Hansa Dr, Castle Hayne, NC 28429-5863 | 2020-10-12 |
| 1124625504 | Tiffany Anne Swanson | Family Medicine | 405 Climax St, Graham, NC 27253-1608 | 2020-10-08 |
| 1235745985 | Alegis Care - North Carolina PC | Family Medicine | 11016 Rushmore Dr Ste 300, Charlotte, NC 28277-3651 | 2020-09-18 |
| 1902411077 | Carolina Medical Partners Pllc | Family Medicine | 10535 Flennigan Way, Charlotte, NC 28277-1417 | 2020-09-15 |
| 1558975433 | Kerr Area Rural Medical Alliance Pllc | Family Medicine | 266 Raymond Tharrington Rd, Louisburg, NC 27549-9687 | 2020-09-08 |
| 1083226906 | Relymd Medical Group Nc, Pllc | Family Medicine | 212 S Tryon St Ste 1000, Charlotte, NC 28281-0001 | 2020-08-21 |
| 1184233884 | Brittany Joyce Mcneil | Family Medicine | 1010 S 16th St, Wilmington, NC 28401-8018 | 2020-07-28 |
| Find all providers with the same taxonomy | ||||
| City | MOORESEVILLE |
| Zip Code | 28117 |
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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.