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).
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 |
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 |
State | Issuer | Identifier | Type Code |
---|---|---|---|
MS | 09851011 | 05 |
Street Address |
139 COUNTY ROAD 379 |
City | WATER VALLEY |
State | MS |
Zip Code | 38965-3607 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1578692463 | Sandra Clark | Radiologic Technologist | 139 County Road 379, Water Valley, MS 38965-3607 | 2007-03-05 |
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 |
Find all providers in zip 38965 |
Taxonomy Code | 335V00000X |
Grouping | Suppliers |
Classification | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier |
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] |
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 |
Find all providers with the same taxonomy |
City | WATER VALLEY |
Zip Code | 38965 |
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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.