JASON H CLARK & SANDRA J CLARK


Address: 139 County Road 379, Water Valley, MS 38965-3607
Phone: 6625145215

JASON H CLARK & SANDRA J CLARK (NPI# 1912185927) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1912185927
Entity Type Organization
Organization Name JASON H CLARK & SANDRA J CLARK
Practice Address 139 County Road 379
Water Valley
MS 38965-3607
Mailing Address Po Box 994
Oxford
MS 38655-0994
Practice Telephone 6625145215
Practice Fax Number 6622340172
Mailing Telephone 6625145215
Mailing Fax Number 6622340172
Enumeration Date 2008-02-01
Last Update Date 2008-12-03
Authorized Official Name JASON CLARK (OWNER)
Authorized Official Telephone 6625145215
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 335V00000X Portable X-ray and/or Other Portable Diagnostic Imaging Supplier MRT2279 MS Suppliers

Other Provider Identifier

State Issuer Identifier Type Code
MS 09851011 05

Office Location

Street Address 139 COUNTY ROAD 379
City WATER VALLEY
State MS
Zip Code 38965-3607

Providers in the same location

NPI Name Taxonomy Address Enumeration
1578692463 Sandra Clark Radiologic Technologist 139 County Road 379, Water Valley, MS 38965-3607 2007-03-05

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1083087985 Family Health Care Clinic, Inc. Clinic/Center 102 Blackmur Dr, Water Valley, MS 38965 2015-11-02
1770713893 Ben F Toole Counselor 1285 County Road 151, Water Valley, MS 38965 2009-07-23
1053451880 North Mississippi Foot Specialists PC Durable Medical Equipment & Medical Supplies 630 South Main St, Water Valley, MS 38965 2007-02-08
1003977281 Barney Lee Pullen Jr. Dentist 117 Wood St, Water Valley, MS 38965 2006-12-12
1912070277 Water Valley Rural Health Paul Odom Md Clinic/Center 645 South Main Street, Water Valley, MS 38965 2006-11-16
1255414173 Family Practice Clinic of Water Valley Family Medicine 606 So Main St, Water Valley, MS 38965 2006-10-23
1073609467 Paul Leroy Odom Family Medicine 604 South Main Street, Water Valley, MS 38965 2006-10-05
1730129164 Quality Medical Service, Inc Durable Medical Equipment & Medical Supplies Quality Medical Services, Inc, 48 S Main Street, Water Valley, MS 38965 2006-06-07
1124687207 Dontavious Toles Physical Therapy Assistant 50 Main St, Water Valley, MS 38965 2019-06-11
1669826111 Antoinette Taylor Family Medicine 604 S Main St, Water Valley, MS 38965 2016-04-21
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Taxonomy Information

Taxonomy Code 335V00000X
Grouping Suppliers
Classification Portable X-ray and/or Other Portable Diagnostic Imaging Supplier

Taxonomy Definition

A supplier that provides one or more of the following portable services, including but not limited to, x-ray, electrocardiogram (EKG), long-term EKG (Holter Monitor), bone densitometry, sonography, and other imaging services in accordance with all state and federal requirements, under the general supervision of a qualified physician. All necessary resources are transported to the patient's location where the services are performed.
Notes: Source: National Uniform Claim Committee, 2015 [1/1/2016: title and definition modified]

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1497117899 Gamma Healthcare, Inc Portable X-ray and/or Other Portable Diagnostic Imaging Supplier 3346 Goodman Rd E, Southaven, MS 38672-6433 2016-03-24
1093175838 Precision Ultrasound Imaging Inc. Portable X-ray and/or Other Portable Diagnostic Imaging Supplier 730 Ridgewood Rd Ste B, Ridgeland, MS 39157-4434 2016-03-04
1992084172 Accurate Medical Diagnostics, LLC Portable X-ray and/or Other Portable Diagnostic Imaging Supplier 660 Katherine Dr, Jackson, MS 39232-8847 2011-08-05
1164496626 Mississippi Mobile Diagnostics Portable X-ray and/or Other Portable Diagnostic Imaging Supplier 730 Ridgewood Rd, Suite B, Ridgeland, MS 39157-4426 2006-02-13
1326040841 Mobile Services, Inc Portable X-ray and/or Other Portable Diagnostic Imaging Supplier 1807 24th Ave, Meridian, MS 39301-3116 2005-08-15
1114582848 Total Imaging of Mississippi Portable X-ray and/or Other Portable Diagnostic Imaging Supplier 1216 11th Ave, Meridian, MS 39301-4443 2019-05-08
1407305030 Medfusion, LLC Portable X-ray and/or Other Portable Diagnostic Imaging Supplier 2 Old River Pl, Suite C, Jackson, MS 39202-3435 2016-09-23
1932489812 Portable Medical Diagnostics LLC Portable X-ray and/or Other Portable Diagnostic Imaging Supplier 1855 Lakeland Dr, Ste G10, Jackson, MS 39216-4913 2011-08-23
1619204203 Pioneer Medical Portable Xray,llc Portable X-ray and/or Other Portable Diagnostic Imaging Supplier 100 Clarendon Ave, Petal, MS 39465-2636 2009-11-03
1063625960 Bladder Control Solutions, Inc Portable X-ray and/or Other Portable Diagnostic Imaging Supplier 100 Maxwell Dr, Vicksburg, MS 39183 2007-05-07
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Competitor

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City WATER VALLEY
Zip Code 38965

Improve Information

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Dataset Information

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.

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