Clark, Kathy S
Clark, Kathy S is an individual health care provider with primary practice located at 5901 Technology Center Dr , Indianapolis IN 46278-6013. She recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as her primary health care specialty. Clark, Kathy S can be contacted via phone (317) 328-5050.Contact Information
Primary practice address
5901 Technology Center Dr
Indianapolis IN 46278-6013
Phone: (317) 328-5050
Fax: (317) 715-9965
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Diagnostic Radiology | 2085R0202X | 01036050A | Indiana |
Profile Details
| NPI number | 1952304701 |
|---|---|
| LBN Legal business name | Clark, Kathy S |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 24th, 2005 |
| Last updated | Oct 3rd, 2016 - about 10 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1952304701 | NPPES |
| Indiana | Other | 000000214716 | ANTHEM-351158723 |
| Indiana | Other | 300128808 | ANTHEM-351158723 |
| Indiana | Other | 000000492338 | ANTHEM-351158723 |
| Indiana | MEDICAID | 100348870 | ANTHEM-351158723 |
| Indiana | Other | 085331 | ANTHEM-351158723 |
| Indiana | Other | Q0085630 | ANTHEM-351158723 |
| Indiana | Other | 011838 | ANTHEM-351158723 |
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