Provider Demographics
NPI:1316113764
Name:DR JEAN M CLAY, PC
Entity type:Organization
Organization Name:DR JEAN M CLAY, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:CLAY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:757-220-3338
Mailing Address - Street 1:302 BULIFANTS BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-5738
Mailing Address - Country:US
Mailing Address - Phone:757-220-3338
Mailing Address - Fax:757-220-8809
Practice Address - Street 1:302 BULIFANTS BLVD STE 101
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-5738
Practice Address - Country:US
Practice Address - Phone:757-220-3338
Practice Address - Fax:757-220-8809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5488750001Medicare NSC