Provider Demographics
NPI:1306907894
Name:CLARK COUNTY AUDITOR
Entity type:Organization
Organization Name:CLARK COUNTY AUDITOR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:BENTFIELD
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:812-282-7521
Mailing Address - Street 1:1201 WALL STREET
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3887
Mailing Address - Country:US
Mailing Address - Phone:812-282-7521
Mailing Address - Fax:812-288-2711
Practice Address - Street 1:1201 WALL STREET
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3887
Practice Address - Country:US
Practice Address - Phone:812-282-7521
Practice Address - Fax:812-288-2711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No261QP0904XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, Federal
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100074760Medicaid
IN300032061Medicaid