| J.douglas Clark, MD PC | |
|
2030 North Church Place Spartanburg SC 29303-2796 | |
| (864) 582-6858 | |
| (864) 585-0999 |
| Full Name | J.douglas Clark, MD PC |
|---|---|
| Speciality | Internal Medicine |
| Location | 2030 North Church Place, Spartanburg, South Carolina |
| Authorized Official Name and Position | Darla M Brown (OFFICE MANAGER) |
| Authorized Official Contact | 8645826858 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| J.douglas Clark, MD PC Po Box 4276 Spartanburg SC 29305-4276 Ph: (864) 582-6858 | J.douglas Clark, MD PC 2030 North Church Place Spartanburg SC 29303-2796 Ph: (864) 582-6858 |
| NPI Number | 1730229808 |
|---|---|
| Provider Enumeration Date | 02/07/2007 |
| Last Update Date | 06/11/2012 |
| Medicare PECOS PAC ID | 7315195609 |
|---|---|
| Medicare Enrollment ID | O20120911000534 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730229808 | NPI | - | NPPES |
| T3660 | Medicaid | SC | |
| 8688 | Other | SC | MBPG'S |
| 290009501 | Other | SC | RAILROAD |
| Provider Name | John Douglas Clark |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1194798595 PECOS PAC ID: 8426074238 Enrollment ID: I20051020000955 |
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