Provider Demographics
NPI:1609573369
Name:CLAVON CLINIC, LLC
Entity type:Organization
Organization Name:CLAVON CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:KELVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:JR
Authorized Official - Credentials:CO
Authorized Official - Phone:240-750-4599
Mailing Address - Street 1:4915 SAINT ELMO AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-6077
Mailing Address - Country:US
Mailing Address - Phone:240-970-1780
Mailing Address - Fax:240-970-1781
Practice Address - Street 1:4915 SAINT ELMO AVE STE 300
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-6077
Practice Address - Country:US
Practice Address - Phone:240-970-1780
Practice Address - Fax:240-970-1781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-13
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier