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THE CLARK CLINIC, INC. - Florida Company Profile

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Company Details

Entity Name: THE CLARK CLINIC, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 09 Oct 2002 (23 years ago)
Last Event: AMENDMENT
Event Date Filed: 11 Jan 2023 (3 years ago)
Document Number: P02000108873
FEI/EIN Number 542078370
Address: 212 SOUTH FLORIDA STREET, BUSHNELL, FL, 33513, US
Mail Address: 212 SOUTH FLORIDA STREET, BUSHNELL, FL, 33513, US
ZIP code: 33513
City: Bushnell
County: Sumter
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
CLARK LOWELL FMD President 212 SOUTH FLORIDA STREET, BUSHNELL, FL, 33513
CLARK LOWELL FMD Director 212 SOUTH FLORIDA STREET, BUSHNELL, FL, 33513
CLARK LOWELL FMD Treasurer 212 SOUTH FLORIDA STREET, BUSHNELL, FL, 33513
CLARK ELIZABETH E Vice President 212 SOUTH FLORIDA STREET, BUSHNELL, FL, 33513
CLARK LOWELL FMD Agent 212 SOUTH FLORIDA STREET, BUSHNELL,, FL, 33513

Commercial and government entity program

CAGE number:
93C17
Status:
Active
Type:
Non-Manufacturer
CAGE Update Date:
2023-06-23
CAGE Expiration:
2026-07-14
SAM Expiration:
2022-10-10

Contact Information

POC:
AMBER FOLK

National Provider Identifier

NPI Number:
1134873011
Certification Date:
2022-02-09

Authorized Person:

Name:
LOWELL F. CLARK
Role:
MEDICAL DIRECTOR
Phone:

Taxonomy:

Selected Taxonomy:
207R00000X - Internal Medicine Physician
Is Primary:
Yes

Contacts:

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G19000004195 CLARK HEALTH EXPIRED 2019-01-09 2024-12-31 - 212 SOUTH FLORIDA STREET, BUSHNELL, FL, 33513
G08009700017 CLARK CLINIC, INC. EXPIRED 2008-01-09 2013-12-31 - 212 SOUTH FLORIDA STREET, BUSHNELL, FL, 33513

Events

Event Type Filed Date Value Description
AMENDMENT 2023-01-11 - -
REGISTERED AGENT NAME CHANGED 2013-01-18 CLARK, LOWELL F, MD -

Documents

Name Date
ANNUAL REPORT 2024-02-06
ANNUAL REPORT 2023-01-23
Amendment 2023-01-11
ANNUAL REPORT 2022-01-24
ANNUAL REPORT 2021-01-16
ANNUAL REPORT 2020-01-19
ANNUAL REPORT 2019-02-14
ANNUAL REPORT 2018-02-11
ANNUAL REPORT 2017-01-10
ANNUAL REPORT 2016-02-14

OSHA's Inspections within Industry

Inspection Summary

Date:
2004-05-28
Type:
Complaint
Address:
212 S FLORIDA ST, BUSHNELL, FL, 33513
Safety Health:
Health
Scope:
Partial

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Date of last update: 02 Aug 2025

Sources: Florida Department of State