DR. ERICA ROUSSEAU CLARK (NPI# 1255635389) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1255635389 |
Entity Type | Individual |
Full Name | DR. ERICA ROUSSEAU CLARK |
Credential | D.O. |
Practice Address |
225 E Wood St Spartanburg SC 29303-3050 |
Mailing Address |
Po Box 743070 Atlanta GA 30374-3070 |
Practice Telephone | 8645604420 |
Enumeration Date | 2011-01-04 |
Last Update Date | 2020-01-22 |
Gender Code | F |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 208600000X | Surgery | 4772 | SC | Allopathic & Osteopathic Physicians |
Y | 2086S0129X |
Surgery Specialization: Vascular Surgery |
4772 | SC | Allopathic & Osteopathic Physicians |
State | Issuer | Identifier | Type Code |
---|---|---|---|
SC | MEDICARE PIN | SCG3103365 | 01 |
SC | 047728 | 05 | |
TN | Q027415 | 05 | |
SC | MEDICARE PIN | SCG3105019 | 01 |
SC | MEDICARE PIN | SCG3109225 | 01 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1578051280 | Erica La'shay Clark | Home Health | 100 E 216th St, Euclid, OH 44123-1155 | 2018-04-27 |
1730546656 | Erica Clark | Counselor | 2209 Roosevelt Ave, Shreveport, LA 71104-2773 | 2016-01-22 |
1154944890 | Erica Clark | Counselor | 8915 Sw Center St, Tigard, OR 97223-6307 | 2020-05-28 |
1639715329 | Erica Clark | Technician | 4955 S Durango Dr Ste 120, Las Vegas, NV 89113-1054 | 2019-11-18 |
1184277881 | Erica Clark | Technician | 1005 Terminal Way Ste 125, Reno, NV 89502-2198 | 2019-07-22 |
1265909311 | Erica Clark | Licensed Vocational Nurse | 24969 Mulholland Hwy, Calabasas, CA 91302-2366 | 2018-10-26 |
1023510708 | Erica Clark | Nurse Practitioner | 7991 S Suncoast Blvd, Homosassa, FL 34446-5005 | 2018-03-08 |
1174033443 | Erica Lynn Clark | Behavior Technician | 308 Gratiot Ave, Alma, MI 48801-1809 | 2017-10-02 |
1154730174 | Erica J. Clark | Psychologist | 200 S Hoover Blvd, Suite #165, Tampa, FL 33609-3540 | 2014-08-04 |
1598081143 | Erica Lee Clark | Day Training, Developmentally Disabled Services | 425 W 3rd St, Powell, WY 82435-2304 | 2010-04-07 |
Street Address |
225 E WOOD ST |
City | SPARTANBURG |
State | SC |
Zip Code | 29303-3050 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1609876374 | William Cuyler Calton Jr. | Surgery | 225 E Wood St, Spartanburg, SC 29303-3050 | 2005-07-26 |
1598132961 | Blaine David Buchanan | Physician Assistant | 225 E Wood St, Spartanburg, SC 29303-3050 | 2015-09-01 |
1316335854 | Becky Williams | Nurse Practitioner | 225 E Wood St, Spartanburg, SC 29303-3050 | 2015-01-07 |
1558764654 | Christy Flores I | Nurse Practitioner | 225 E Wood St, Spartanburg, SC 29303-3050 | 2014-10-02 |
1982023339 | Christopher James Edenfield | Physician Assistant | 225 E Wood St, Spartanburg, SC 29303 | 2014-04-14 |
1841587797 | Ronald Howard Figura | Surgery | 225 E Wood St, Spartanburg, SC 29303 | 2011-06-29 |
1124330014 | Susan Grizzard Peterson | Nurse Practitioner | 225 E Wood St, Spartanburg, SC 29303-3050 | 2010-07-08 |
1356537161 | Phillip Brent Reustle | Physician Assistant | 225 E Wood St, Spartanburg, SC 29303-3050 | 2007-09-15 |
1982803144 | Charles Jason Rousseau | Surgery | 225 E Wood St, Spartanburg, SC 29303-3050 | 2007-07-17 |
1730219205 | Scott Marion Hovis | Surgery | 225 E Wood St, Suite G, Spartanburg, SC 29303-3050 | 2007-03-06 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1013532126 | Adam Joseph Fulcher | Family Medicine | Center for Family Medicine, 853 N. Church Street, Suite 510, Spartanburg, SC 29303 | 2020-06-15 |
1275011652 | Tri-state Medical Supplies, North Grove | Durable Medical Equipment & Medical Supplies | 1330 Boiling Springs Rd Ste 2900, Spartanburg, SC 29303 | 2018-07-30 |
1992227151 | Roxanne Pope | Speech-Language Pathologist | 290 N Grove Medical Park Dr., Spartanburg, SC 29303 | 2017-07-10 |
1861934879 | Cortney Redmond Mckinney I | Counselor | 250 Dewey Sve., Spartanburg, SC 29303 | 2016-11-08 |
1578011474 | Instride Foot and Ankle Specialists, Pllc | Podiatrist | 269 North Grove Medical Drive, Spartanburg, SC 29303 | 2016-09-20 |
1023477536 | Whitney Brooke Terry | Physician Assistant | 391 Serpentine Dr Ste 250, Spartanburg, SC 29303 | 2016-02-12 |
1306244348 | Medcare Urgent Care Spartanburg, LLC | Clinic/Center | 301 E Wood Street, Spartanburg, SC 29303 | 2014-12-08 |
1508201393 | Tom Ju | Anesthesiology | 1330 Boiling Springs Rd Ste 2700, Spartanburg, SC 29303 | 2013-05-07 |
1295072312 | Marie O'dell | Registered Nurse | 7 698 Howard Street, Spartanburg School District, Spartanburg, SC 29303 | 2013-01-09 |
1518203330 | Sherard Hamilton Ansley | Speech-Language Pathologist | 698 Howard St., Spartanburg School District 7, Spartanburg, SC 29303 | 2012-12-26 |
Find all providers in zip 29303 |
Taxonomy Code | 2086S0129X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Surgery |
Specialization | Vascular Surgery |
A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1962519546 | Mary Black Health System LLC | Surgery | 1690 Skylyn Dr Ste 350, Spartanburg, SC 29307-1039 | 2006-08-23 |
1609876374 | William Cuyler Calton Jr. | Surgery | 225 E Wood St, Spartanburg, SC 29303-3050 | 2005-07-26 |
1043547102 | John Bottsford | Surgery | 385 Serpentine Dr, Ste B, Spartanburg, SC 29303-3018 | 2009-11-11 |
1730219205 | Scott Marion Hovis | Surgery | 225 E Wood St, Suite G, Spartanburg, SC 29303-3050 | 2007-03-06 |
1508847005 | John Eugene Bottsford Jr. | Surgery | 385 Serpentine Dr, Suite A, Spartanburg, SC 29303-3018 | 2005-11-10 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1740840024 | Tyler Buckley | Surgery | 169 Ashley Ave, Room 202 Main Hospital, Msc333, Charleston, SC 29425 | 2019-06-18 |
1043766017 | Charleston Vascular Surgery, P.C. | Surgery | 1280 Hospital Drive, Suite 302, Charleston Vascular Surgery, P.C., Mount Pleasant, SC 29464-1901 | 2016-08-30 |
1104237338 | William Jackson | Surgery | 101 S Ravenel St Ste 230, Florence, SC 29506-2624 | 2014-05-09 |
1962765081 | Goatee Vascular LLC | Surgery | 4036 River Oaks Dr, Unit B2, Myrtle Beach, SC 29579-6695 | 2012-06-22 |
1518149350 | Thomas Russell Wieters, M.d., P.a. | Surgery | 3070 Highway 17 N, Suite 202, Mount Pleasant, SC 29466-9300 | 2007-12-04 |
1801985007 | Thomas C. Appleby | Surgery | 1327 Ashley River Road, Building B, Charleston, SC 29407 | 2006-10-12 |
1164536215 | Sean J Hislop | Surgery | 1327 Ashley River Rd, Charleston, SC 29407-5384 | 2006-08-18 |
1881600963 | Louis F Knoepp IIi | Surgery | 100 Health Way, Suite 1240, Anderson, SC 29621-7917 | 2006-07-31 |
1659321115 | Robert C. Allen | Surgery | 197 Piedmont Blvd Ste 100, Rock Hill, SC 29732-1824 | 2006-05-12 |
1164496527 | The Regional Medical Center of Orangeburg and Calhoun Counties | Surgery | 1175 Cook Rd Ste 320, Orangeburg, SC 29118-8247 | 2006-02-14 |
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City | SPARTANBURG |
Zip Code | 29303 |
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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.