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SOUTHWEST ANTI-AGING CENTER
NPI 1083085385
Internal Medicine in Amarillo, TX

Active since October 13, 2015CLIA 45D2175783 · Waiver
5701 TIME SQUARE BLVD STE 220, AMARILLO, TX 79119(806) 350-7311(806) 350-7361 Get Directions Write a Review

NPPES record last updated: November 9, 2017. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Southwest Anti-aging Center NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTHWEST ANTI-AGING CENTER (NPI 1083085385) is a healthcare organization registered as an internal medicine in Amarillo, Texas and active in the NPI registry since October 2015. The organization holds a CLIA Waiver certificate valid through December 1, 2027 and lists Kathleen Anne Clark, Md, as its authorized official.

NPPES Registry Identity

NPI1083085385
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameKATHLEEN A. CLARK MD PA
Location Address5701 TIME SQUARE BLVD STE 220Amarillo, TX 79119-1178
Mailing Address5701 Time Square Blvd Ste 220Amarillo, TX 79119-1178 · (806) 350-7311 · Fax (806) 350-7361
Phone(806) 350-7311
Fax(806) 350-7361
Organization SubpartNo
Authorized OfficialKathleen Anne ClarkMd · (806) 350-7311
Enumeration DateOctober 13, 2015
Last NPPES UpdateNovember 9, 2017
✔ NPI 1083085385 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
License✔ Licensed in TX · P8871
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
5701 TIME SQUARE BLVD STE 220, Amarillo, TX 79119
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Other Names 1

Doing Business AsSouthwest Anti-aging Center

Other Identifiers 1

Other1083085385TX · Npi

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 45D2175783

Kathleen A Clark, MD PA · Amarillo, TX
Active · expires Dec 1, 2027
CLIA Number45D2175783
Laboratory TypePhysician Office
Certificate Effective DateDecember 2, 2025
Certificate Expiration DateDecember 1, 2027
Laboratory DirectorKathleen A. Clark
Laboratory Phone(806) 350-7311
Laboratory LocationKathleen A Clark, MD PA5701 Time Square Blvd Suite 220, Amarillo, TX 79119
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KATHLEEN ANNE CLARK M.D.
Internal Medicine
5701 TIME SQUARE BLVD STE 220
AMARILLO, TX 79119
Randall County (806) 350-7311

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kathleen A. Clark MD PA's NPI number?

The NPI number for Kathleen A. Clark MD PA is 1083085385. It was assigned to this organization in the NPPES registry on October 13, 2015. The provider is doing business as Southwest Anti-Aging Center.

Where is Kathleen A. Clark MD PA located?

Kathleen A. Clark MD PA is located at 5701 Time Square Blvd Ste 220, Amarillo, TX 79119. The listed phone number is (806) 350-7311.

What is Kathleen A. Clark MD PA's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Does Kathleen A. Clark MD PA hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 45D2175783) is associated with this NPI, valid through December 1, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Kathleen A. Clark MD PA was last updated on November 9, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.