MR. KEVIN S CLARK M.M.S. PA-C NPI 1235370743

NPI Information

NPI: 1235370743
Provider Name: MR. KEVIN S CLARK, M.M.S., PA-C
Classification: Physician Assistant - 363AM0700X
Entity Type: Individual

Specialization: Medical

Organization: FLORIDA HEALTH CARE PLAN INC

PECOS Registration: Yes

Address:
4500 MEMORIAL DR
BELLEVILLE, IL
ZIP 62226
Phone: (618) 233-7750
Get Directions

MR. Kevin S Clark, M.M.S., PA-C is a medical physician assistant in Belleville, IL with 25 years of experience. MR. Kevin S Clark, M.M.S., PA-C NPI is 1235370743. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

4500 MEMORIAL DR
BELLEVILLE, IL
ZIP 62226-360
Phone: (618) 233-7750

The NPI 1235370743 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 3/12/2009 and was last updated on 1/3/2013.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207P00000X	Emergency Medicine		085003431	ILLINOIS	No
2	363AM0700X	Physician Assistant	Medical	085003431	ILLINOIS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	IL1682028	MEDICARE PIN	ILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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