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Jason H Clark & Sandra J Clark
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier in Water Valley, Mississippi
NPI 1912185927

Jason H Clark & Sandra J Clark is a Portable X-ray and/or Other Portable Diagnostic Imaging Supplier based in Oxford, MS. Jason H Clark & Sandra J Clark practices in Water Valley, MS. The NPI Number for Jason H Clark & Sandra J Clark is 1912185927 and holds a License No. MRT2279 (Mississippi).

The current practice location address for Jason H Clark & Sandra J Clark is 139 County Road 379, Water Valley, MS and can be reached out via phone at 662-514-5215 and via fax at 662-234-0172.

Location: 139 County Road 379, Water Valley, MS, 38655-0994
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1912185927
Provider Name
Jason H Clark & Sandra J Clark
Credential
Provider Entity Type
Organization
Address
139 County Road 379, Water Valley, MS, 38655-0994
Phone Number
662-514-5215
Fax Number
662-234-0172
Provider Enumeration Date
02/01/2008
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
09851011 05 MS
institution
Provider Business Practice Location Address Details
Address
139 County Road 379
City
Water Valley
State
Mississippi
Zip
38965-3607
Phone Number
662-514-5215
Fax Number
662-234-0172
person
Provider Business Mailing Address Details
Address
139 County Road 379
City
Water Valley
State
Mississippi
Zip
38965-3607
Phone Number
662-514-5215
Fax Number
662-234-0172
person
Provider's Taxonomy Details 1
Type
Suppliers
Classification
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
Speciality
-
Taxonomy
335V00000X
License No.
MRT2279 (Mississippi)
Definition
A supplier that provides one or more of the following portable services, including but not limited to, x-ray, electrocardiogram (EKG), long-term EKG (Holter Monitor), bone densitometry, sonography, and other imaging services in accordance with all state and federal requirements, under the general supervision of a qualified physician. All necessary resources are transported to the patient's location where the services are performed.
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