| Gregory Scott Clark, CRNA | |
|
3333 W Deyoung St, Marion, IL 62959-5884 | |
| (618) 998-7000 | |
| Not Available |
| Full Name | Gregory Scott Clark |
|---|---|
| Gender | Male |
| Speciality | Nurse Anesthetist, Certified Registered |
| Location | 3333 W Deyoung St, Marion, Illinois |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528627833 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 367500000X | Nurse Anesthetist, Certified Registered | 123868 (Missouri) | Primary |
| 367500000X | Nurse Anesthetist, Certified Registered | 209019721 (Illinois) | Secondary |
| Entity Name | Good Samaritan Regional Health Center |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1487758801 PECOS PAC ID: 1658272059 Enrollment ID: O20040119000325 |
| Entity Name | Southern Illinois Medical Services Nfp |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1770656837 PECOS PAC ID: 3678677390 Enrollment ID: O20070404000595 |
| Mailing Address | Practice Location Address |
|---|---|
| Gregory Scott Clark, CRNA 262 Woodland Hill Rd, Poplar Bluff, MO 63901-1870 Ph: (573) 778-5706 | Gregory Scott Clark, CRNA 3333 W Deyoung St, Marion, IL 62959-5884 Ph: (618) 998-7000 |
David I Blue, CRNA Nurse Anesthetist - CR Medicare: Not Enrolled in Medicare Practice Location: 3333 W Deyoung St, Marion, IL 62959 Phone: 618-998-7000 | |
Mr. George E Wiggins, CRNA Nurse Anesthetist - CR Medicare: Not Enrolled in Medicare Practice Location: 12266 Deer Run Rd, Marion, IL 62959 Phone: 618-964-1223 | |
Jason L Vallette, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 3333 W Deyoung St, Marion, IL 62959 Phone: 660-826-5960 Fax: 660-826-4852 | |
Mrs. Lisa Goff Pagel, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 2401 W Main St, Marion, IL 62959 Phone: 618-997-5311 | |
Joseph Specker Iv, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 3333 W Deyoung St, Marion, IL 62959 Phone: 228-861-1192 Fax: 618-997-1122 | |
Ms. Karen J. Harbal, CRNA Nurse Anesthetist - CR Medicare: Not Enrolled in Medicare Practice Location: 3003 Civic Circle Blvd, Marion, IL 62959 Phone: 618-993-1112 Fax: 618-993-1113 | |
Mr. Timothy Lee Ford, CRNA Nurse Anesthetist - CR Medicare: Not Enrolled in Medicare Practice Location: 2401 W Main St, Marion, IL 62959 Phone: 618-997-5311 |