Clark, Susan R
Clark, Susan R is an individual health care provider with primary practice located at 1728 S Hawthorne Rd , Winston Salem NC 27103-4016. She recently has only one registered license in Other Service Providers / Prosthetics Case Management, which is considered as her primary health care specialty. Clark, Susan R can be contacted via phone (336) 768-3666.Contact Information
Primary practice address
1728 S Hawthorne Rd
Winston Salem NC 27103-4016
Phone: (336) 768-3666
Fax: (336) 768-3468
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Prosthetics Case Management | 1744P3200X |
Profile Details
| NPI number | 1063545077 |
|---|---|
| LBN Legal business name | Clark, Susan R |
| Credentials | CPO |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 13th, 2007 |
| Last updated | Jul 9th, 2007 - about 17 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 | 1063545077 | NPPES |
| North Carolina | MEDICAID | 7795038 |
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