| Clark Integrated Medical Clinics Llc | |
|
130 Rue Beauregard Ste A Lafayette LA 70508-3130 | |
| (337) 232-3353 | |
| (337) 232-9304 |
| Full Name | Clark Integrated Medical Clinics Llc |
|---|---|
| Speciality | General Practice |
| Location | 130 Rue Beauregard Ste A, Lafayette, Louisiana |
| Authorized Official Name and Position | Jacob Scott Clark (OWNER) |
| Authorized Official Contact | 3372323353 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Clark Integrated Medical Clinics Llc 130 Rue Beauregard Ste A Lafayette LA 70508-3130 Ph: (337) 232-3353 | Clark Integrated Medical Clinics Llc 130 Rue Beauregard Ste A Lafayette LA 70508-3130 Ph: (337) 232-3353 |
| NPI Number | 1124529284 |
|---|---|
| Provider Enumeration Date | 02/23/2018 |
| Last Update Date | 12/09/2020 |
| Medicare PECOS PAC ID | 8022372598 |
|---|---|
| Medicare Enrollment ID | O20180509000736 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124529284 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Jacob S Clark |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1003864620 PECOS PAC ID: 0648171371 Enrollment ID: I20040116000045 |
| Provider Name | Brad A Boudreaux |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1811076995 PECOS PAC ID: 6800998105 Enrollment ID: I20070216000121 |
| Provider Name | Jake M Gary |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1033400585 PECOS PAC ID: 0648448357 Enrollment ID: I20110725000580 |
| Provider Name | Matthew C Smith |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1588074272 PECOS PAC ID: 2365669892 Enrollment ID: I20140807000377 |
| Provider Name | Kris Frankenberg |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1194800730 PECOS PAC ID: 0143111351 Enrollment ID: I20190115000828 |
| Provider Name | Joshua C. Couvillon |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1235673864 PECOS PAC ID: 8426318247 Enrollment ID: I20190424001722 |
| Provider Name | Amy Weatherford |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184240608 PECOS PAC ID: 1759707789 Enrollment ID: I20200820001836 |
| Provider Name | Kayla N Conway-brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285314559 PECOS PAC ID: 5890159826 Enrollment ID: I20230911000321 |
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