Basic Information
| Provider Information | |||||||||
| NPI: | 1629012208 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLEMENTS | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | D.P.M. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 3 RIVERSIDE CIR | ||||||||
| Address2: | |||||||||
| City: | ROANOKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240164955 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5407251226 | ||||||||
| FaxNumber: | 5408575306 | ||||||||
| Practice Location | |||||||||
| Address1: | 3 RIVERSIDE CIR | ||||||||
| Address2: | |||||||||
| City: | ROANOKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240164955 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5407251226 | ||||||||
| FaxNumber: | 5408575306 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2006 | ||||||||
| LastUpdateDate: | 03/21/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | 0103300956 | VA | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist |
ID Information
| ID | Type | State | Issuer | Description | 1629012208 | 01 | VA | VIRGINIA HEALTH NETWORK | OTHER | 1629012208 | 01 | VA | HEALTHKEEPERS | OTHER | 1629012208 | 05 | VA | MEDICAID | 371194700 | 01 | VA | BLACK LUNG | OTHER | 1629012208 | 01 | VA | AETNA | OTHER | 1629012208 | 01 | VA | HUMANA MEDICARE | OTHER | 3810011217 | 01 | VA | MEDICAID OF WEST VIRGINIA | OTHER | 1629012208 | 01 | VA | ANTHEM | OTHER | 1629012208 | 01 | VA | OPTIMA HEALTH PLAN | OTHER | 1629012208 | 01 | VA | UNITED HEALTHCARE | OTHER | 1629012208 | 01 | VA | VA PREMIER | OTHER | 1629012208 | 01 | VA | NPI | OTHER | 1629012208 | 01 | VA | CAREWORKS | OTHER | 1629012208 | 01 | VA | HEALTHKEEPERS PLUS | OTHER | 1629012208 | 01 | VA | UMWA | OTHER | 1629012208 | 01 | VA | CIGNA | OTHER | 1629012208 | 01 | VA | SOUTHERN HEALTH/CARENET/CARELINK/COVENTRY | OTHER | P00403951 | 01 | VA | RAILROAD MEDICARE | OTHER | 1629012208 | 01 | VA | GATEWAY | OTHER | 1629012208 | 01 | VA | MAJESTACARE | OTHER | 1629012208 | 01 | VA | INTOTAL | OTHER | 540506332108 | 01 | VA | TRICARE | OTHER |