CLEAR WATER MEDICAL LLC (NPI# 1043512783) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043512783 |
| Entity Type | Organization |
| Organization Name | CLEAR WATER MEDICAL LLC |
| Practice Address |
4912 Lake Renaissance Cir Wilmington NC 28409-3303 |
| Mailing Address |
Po Box 16310 Wilmington NC 28408-6310 |
| Practice Telephone | 9104652783 |
| Practice Fax Number | 9107944531 |
| Mailing Telephone | 9104652783 |
| Mailing Fax Number | 9107944531 |
| Enumeration Date | 2010-12-01 |
| Last Update Date | 2010-12-01 |
| Authorized Official Name | WILLIAM ANTHONY GORE (MANAGING MEMBER) |
| Authorized Official Telephone | 9104652783 |
| Authorized Official Credential | PA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 101955 | NC | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
4912 LAKE RENAISSANCE CIR |
| City | WILMINGTON |
| State | NC |
| Zip Code | 28409-3303 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952916728 | Emily Savannah Holland | Specialist/Technologist | 1150 King's Hwy, Wilmington, NC 28409 | 2020-09-09 |
| 1912373465 | Thomas Malenfant | Hearing Instrument Specialist | 474 New Centre Drive, #6, Wilmington, NC 28409 | 2015-08-19 |
| 1720482862 | Leslie Morton Garris | Pharmacist | 6013 Chancellorville Drive, Wilmington, NC 28409 | 2014-10-17 |
| 1659621720 | Charles Warren Moorehead | Social Worker | 5710 Oleander Dr. Suite 208, Wilmington, NC 28409 | 2012-09-14 |
| 1992972020 | Nancy Beth Kotz | Social Worker | 6211 Terrapin Ct, Wilmington, NC 28409 | 2008-05-08 |
| 1366611089 | Michael Royce Penland | Psychologist | 5002-1 Hewletts Run, Wilmington, NC 28409 | 2008-02-27 |
| 1184755092 | Keith W Mann | Dentist | 818-101 Pine Grove Drive, Wilmington, NC 28409 | 2007-03-09 |
| 1477650554 | Jeffrey Beecham Chick | Specialist | 1201 Porches Dr, Suite 2, Wilmington, NC 28409 | 2006-09-20 |
| 1407964067 | Richard A. Lally | Counselor | 5425 Golden Eagle Court, Wilmington, NC 28409 | 2006-08-25 |
| 1598290520 | Monaca Lachman | Counselor | 6020 Leeward Ln, Wilmington, NC 28409-0129 | 2017-04-27 |
| Find all providers in zip 28409 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750990461 | Kyra Isaacs | Physician Assistant | 1901 Greenbriar Dr, Wilmington, DE 19810-4320 | 2020-07-28 |
| 1144847252 | Stephanie Marie Barczak | Physician Assistant | 11 Amherst Rd, Wilmington, MA 01887-2608 | 2020-07-06 |
| 1457984676 | Jessica Patrick Lancaster | Physician Assistant | 602 Jennings Dr, Wilmington, NC 28403-2732 | 2020-02-17 |
| 1730727348 | Lea Ann Cenname | Physician Assistant | 722 Mohican Trl, Wilmington, NC 28409-3429 | 2019-12-13 |
| 1467944645 | Julie Renee Sims | Physician Assistant | 3411 Silverside Rd Ste 107, Wilmington, DE 19810-4806 | 2018-06-04 |
| 1740780865 | Greater Tomorrow Wellness, LLC | Physician Assistant | 1097 W Locust St, Wilmington, OH 45177 | 2018-02-15 |
| 1336658657 | Eric Dees | Physician Assistant | 501 W 14th St Fl 1, Wilmington, DE 19801-1013 | 2017-09-29 |
| 1174047591 | Carlie M Black | Physician Assistant | 4815 Oleander Dr Ste 100, Wilmington, NC 28403-5116 | 2017-07-27 |
| 1497294581 | Kathleen Lauren Meyer | Physician Assistant | 6419 Carolina Beach Rd Ste A, Wilmington, NC 28412-3672 | 2017-02-22 |
| 1477090967 | David Romano | Physician Assistant | 15 Kilmarnock St, Wilmington, MA 01887-3061 | 2017-01-23 |
| Find all providers in WILMINGTON | ||||
| City | WILMINGTON |
| Zip Code | 28409 |
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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.