Mckenzie, Clark R
Mckenzie, Clark R is an individual health care provider with primary practice located at 450 N New Ballas Rd Ste 270 W, Saint Louis MO 63195-2632. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Cardiovascular Disease, Allopathic & Osteopathic Physicians / Interventional Cardiology. Allopathic & Osteopathic Physicians / Interventional Cardiology is his primary health care specialty. Mckenzie, Clark R can be contacted via phone (314) 991-6969.Contact Information
Primary practice address
450 N New Ballas Rd Ste 270 W
Saint Louis MO 63195-2632
Phone: (314) 991-6969
Fax: (314) 997-6969
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Cardiovascular Disease | 207RC0000X | R4P62 | Missouri |
| Allopathic & Osteopathic Physicians / Interventional Cardiology | 207RI0011X | R4P62 | Missouri |
Profile Details
| NPI number | 1073506051 |
|---|---|
| LBN Legal business name | Mckenzie, Clark R |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 25th, 2005 |
| Last updated | Jan 19th, 2016 - about 8 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 | 1073506051 | NPPES |
| Missouri | Other | 004013185 | MEDICARE PROV ID AREA 99 |
| Missouri | Other | 1124011010 | MEDICARE PROV ID AREA 99 |
| Missouri | Other | 1881863009 | MEDICARE PROV ID AREA 99 |
| Missouri | Other | P00275849 | MEDICARE PROV ID AREA 99 |
| Missouri | Other | 006012762 | MEDICARE PROV ID AREA 99 |
| Missouri | Other | 110171721 | MEDICARE PROV ID AREA 99 |
| Missouri | Other | 000047049 | MEDICARE PROV ID AREA 99 |
| Missouri | Other | CI7050 | MEDICARE PROV ID AREA 99 |
| Missouri | Other | MA1080 | MEDICARE PROV ID AREA 99 |
| Missouri | Other | 1801889795 | MEDICARE PROV ID AREA 99 |
| Missouri | Other | MA1080001 | MEDICARE PROV ID AREA 99 |
| Missouri | Other | CD6536 | MEDICARE PROV ID AREA 99 |
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