Timothy John Clark, is a
Peer Specialist based in Pendleton, Oregon. Timothy John Clark is licensed to practice in * (Not Available) (license number ) and his current practice location is
17 Sw Frazer Ave Ste 282, Pendleton, Oregon. He can be reached at his office (for appointments etc.) via phone at
(541) 278-6330.
NPI number for Timothy John Clark is 1659810299 and his current mailing address is 17 Sw Frazer Ave Ste 282, Pendleton, Oregon. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1659810299.
Healthcare Provider's Profile
| Full Name | Timothy John Clark |
|---|
| Gender | Male |
|---|
| Speciality | Peer Specialist |
|---|
| Location | 17 Sw Frazer Ave Ste 282, Pendleton, Oregon |
|---|
| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
|---|
NPI Data:
- NPI Number: 1659810299
- Provider Enumeration Date: 02/15/2017
- Last Update Date: 01/29/2020
Medical Identifiers
Medical identifiers for Timothy John Clark such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1659810299 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 101Y00000X | Counselor | (* (Not Available)) | Secondary |
| 175T00000X | Peer Specialist | (* (Not Available)) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Timothy John Clark is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Timothy John Clark,
17 Sw Frazer Ave Ste 282,
Pendleton, OR 97801-0048
Ph: (541) 278-6330 | Timothy John Clark,
17 Sw Frazer Ave Ste 282,
Pendleton, OR 97801-0048
Ph: (541) 278-6330 |
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