MR. PHILLIP DOUGLAS CLARK SR. (NPI# 1053912451) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1053912451 |
Entity Type | Individual |
Full Name | MR. PHILLIP DOUGLAS CLARK SR. |
Practice Address |
2126 Highway 9 E Unit 5b Longs SC 29568-5725 |
Mailing Address |
3988 Tybre Ct Little River SC 29566-8483 |
Practice Telephone | 8433538664 |
Practice Fax Number | 8434850047 |
Mailing Telephone | 8433538664 |
Enumeration Date | 2020-11-03 |
Last Update Date | 2020-11-03 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 374U00000X | Home Health Aide | 1264 | Nursing Service Related Providers | |
Y | 374U00000X | Home Health Aide | 1264 | SC | Nursing Service Related Providers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
SC | DRIVER LICENSE | 104613648 | 01 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1629471412 | Phillip Wayne Clark | Nurse Practitioner | 150 E. Tyson Rd, Quartzsite, AZ 85359-4618 | 2014-10-07 |
1881838027 | Phillip J Clark | Counselor | 206 Lilly Rd Ne Apt B5, Olympia, WA 98506-5011 | 2009-04-30 |
1083272934 | Phillip Clark | Physical Therapy Assistant | 4560 Se International Way Ste 100, Milwaukie, OR 97222-4628 | 2019-06-04 |
1568950764 | Phillip A Clark | Counselor | 925 Brockhurst St, Oakland, CA 94608-4222 | 2018-04-24 |
1669991691 | Phillip Clark | Case Manager/Care Coordinator | 9403 Mansfield Rd, Shreveport, LA 71118-3815 | 2017-09-11 |
1194169144 | Phillip Don Clark | Radiology | 1924 Alcoa Hwy # U107, Knoxville, TN 37920-1511 | 2013-04-22 |
Street Address |
2126 HIGHWAY 9 E UNIT 5B |
City | LONGS |
State | SC |
Zip Code | 29568-5725 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1558690305 | Family Life Medicine | Family Medicine | 7209 Hwy 90, Suite C, Longs, SC 29568 | 2009-12-08 |
1932226628 | Home Therapy Inc | Durable Medical Equipment & Medical Supplies | 2126 E Hwy 9, Parkway Plaza Center Bldg G Ste 4, Longs, SC 29568 | 2007-03-26 |
1831238229 | Elaine C Byrd | Speech-Language Pathologist | 2126 Highway 9 E Ste C4, Longs, SC 29568 | 2007-02-05 |
1932612082 | Monica Christine Po | Physician Assistant | 2237 Highway 9 E, Longs, SC 29568-5701 | 2017-11-13 |
1104237924 | Parkway Discount Pharmacy | Pharmacy | 2126 Highway 9 E, Bldg D Suite 9, Longs, SC 29568-5725 | 2014-05-14 |
1164524120 | John S Enloe | Chiropractor | 2126 Hwy 9 East, Bldg D-3, Longs, SC 29568-5725 | 2006-09-01 |
1811078512 | John S. Enloe Iv, D.c., P.C. | Chiropractor | 2126 Hwy 9 East, Bldg D-3, Longs, SC 29568-5725 | 2006-10-18 |
1851759674 | Carolina Medical Supplies LLC | Durable Medical Equipment & Medical Supplies | 2126 Highway 9 E Ste G6, Longs, SC 29568-5734 | 2016-02-08 |
1891329272 | Prs 9, LLC | Physical Therapist | 2126 Highway 9 E Ste E3, Longs, SC 29568-5736 | 2020-02-25 |
1033720628 | Sarah Gerth | Speech-Language Pathologist | 2126 Highway 9 E Ste C4, Longs, SC 29568-5753 | 2020-08-16 |
Find all providers in zip 29568 |
Taxonomy Code | 374U00000X |
Grouping | Nursing Service Related Providers |
Classification | Home Health Aide |
A person trained to assist public health nurses, home health nurses, and other health professionals in the bedside care of patients in their homes. |
Notes: Source: Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1760083570 | Janelle Graham | Home Health Aide | 515 Cool Creek Dr, Rock Hill, SC 29732-7108 | 2020-11-06 |
1497356802 | True To You In-home Patient Care Services,llc | Home Health Aide | 305 E Smith St, Timmonsville, SC 29161-1821 | 2020-11-03 |
1659972909 | Sheila L Knight | Home Health Aide | 412 Waterville Dr, Columbia, SC 29229-8131 | 2020-11-03 |
1326645862 | Angel Hearts Co. LLC | Home Health Aide | 3656 S Irby St Ste C, Florence, SC 29505-5225 | 2020-10-07 |
1306443031 | Shanna Nicole Lewis | Home Health Aide | 214 Doby St, Camden, SC 29020-2312 | 2020-10-06 |
1306452636 | Pamela W Wiggins | Home Health Aide | 242 8th Ave, Aynor, SC 29511-3222 | 2020-09-22 |
1194331082 | Tamara M Grant | Home Health Aide | 1215 Canterbury Rd, Florence, SC 29505-2904 | 2020-09-17 |
1639784549 | Adwell Lerome Scott | Home Health Aide | 819 E Bonnie Ln, Florence, SC 29505-7102 | 2020-09-09 |
1447862206 | Deborah A Russell | Home Health Aide | 235 Herlong Ave S, Rock Hill, SC 29732-1159 | 2020-08-21 |
1982214599 | Tasha Savage | Home Health Aide | 4207 Sea Mountain Hwy Ste C, Little River, SC 29566-6843 | 2020-08-07 |
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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.