JEREMY J CLARK M.D. NPI 1588717417

NPI Information

NPI: 1588717417
Provider Name: JEREMY J CLARK, M.D.
Classification: Obstetrics & Gynecology - 207VG0400X
Entity Type: Individual

Specialization: Gynecology

PECOS Registration: Yes

Address:
401 E CHESTNUT ST
SUITE 410
LOUISVILLE, KY
ZIP 40202
Phone: (502) 271-5999
Get Directions

Jeremy J Clark, M.D. is a gynecology obstetrics gynecology in Louisville, KY. The provider is a physician who specializes in diagnosis, treatment, and management of patients with gynecologic conditions. Source: National Uniform Claim Committee Jeremy J Clark, M.D. NPI is 1588717417. 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:

401 E CHESTNUT ST
SUITE 410
LOUISVILLE, KY
ZIP 40202-700
Phone: (502) 271-5999
Fax: (502) 271-5994

The NPI 1588717417 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 1/22/2007 and was last updated on 11/29/2021.

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	207VG0400X	Obstetrics & Gynecology	Gynecology	41069	KENTUCKY	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	50016301	OTHER	KENTUCKY	PASSPORT SPECIALITY - PSC
2	000000522820	OTHER	KENTUCKY	ANTHEM FOUNDATION
3	000000542980	OTHER	KENTUCKY	ANTHEM - PSC
4	000001568F	OTHER		HUMANA PSC
5	50016302	OTHER	KENTUCKY	PASSPORT SPECIALITY# -FOUNDATION
6	50017315	OTHER	KENTUCKY	PASSPORT PCP# - FOUNDATION
7	200868450	MEDICAID	INDIANA
8	7290926	OTHER		AETNA
9	000001172T	OTHER		HUMANA FOUNDATION
10	7100013410	MEDICAID	KENTUCKY

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: 4/28/2024

NPI Synchronization or Removal

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