Provider Demographics
NPI:1063036119
Name:ST CLAIRE MEDICAL CENTER INC.
Entity Type:Organization
Organization Name:ST CLAIRE MEDICAL CENTER INC.
Other - Org Name:CAUDILL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:H
Authorized Official - Last Name:LLOYD
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:606-783-6502
Mailing Address - Street 1:316 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-1550
Mailing Address - Country:US
Mailing Address - Phone:606-780-5330
Mailing Address - Fax:
Practice Address - Street 1:112 ALLIE YOUNG HALL
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-1684
Practice Address - Country:US
Practice Address - Phone:606-783-2885
Practice Address - Fax:606-783-9106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-04
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty