Clark, Eloise Marie

Clark, Eloise Marie is an individual health care provider with primary practice located at 1720 Highway 59 S , Thief River Falls MN 56701-4331. She recently has only one registered license in Allopathic & Osteopathic Physicians / Obstetrics & Gynecology, which is considered as her primary health care specialty. Clark, Eloise Marie can be contacted via phone (218) 681-4747.

Contact Information

Primary practice address
1720 Highway 59 S Thief River Falls MN 56701-4331
Phone: (218) 681-4747
Fax: (218) 683-2595
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X 47488 Minnesota

Profile Details

NPI number 1912946732
LBN Legal business name Clark, Eloise Marie
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 6th, 2006
Last updated Jan 6th, 2012 - about 12 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1912946732 NPPES
Fm Other 25707 NDBS #
Fm MEDICAID 058453300 NDBS #
Fm MEDICAID 13554 NDBS #
Fm Other 43201 NDBS #
Fm Other 2364648 NDBS #
Fm Other HP53190 NDBS #
Fm Other 137002 NDBS #
Fm Other DA9021044062 NDBS #
Fm Other 0704419 NDBS #
Fm Other 300S9CL NDBS #

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