| Organization Name: | CLARK PHYSICIAN GROUP LLC |
| NPI Number: | 1831344431 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KIRK STRACK (CFO) |
| Mailing Address: | 130 Hunter Station Way Sellersburg |
| State: | IN US |
| Postal Code: | 471728930 |
| Phone Number: | 8122464808 |
| Fax Number: | 8122464807 |
| NPI Enumeration Date: | 11/24/2008 |
| NPI Last Update Date: | 08/17/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QU0200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Urgent Care |
| Taxonomy Definition: | |