Provider Demographics
NPI:1154328482
Name:PATTIE A CLAY INFIRMARY ASSOCIATION
Entity Type:Organization
Organization Name:PATTIE A CLAY INFIRMARY ASSOCIATION
Other - Org Name:PATTIE A CLAY INFIRMARY ASSOCIATION
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAIONCHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-623-1950
Mailing Address - Street 1:648 UNIVERSITY SHOPPING CTR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-2614
Mailing Address - Country:US
Mailing Address - Phone:859-623-1950
Mailing Address - Fax:859-623-0619
Practice Address - Street 1:648 UNIVERSITY SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2614
Practice Address - Country:US
Practice Address - Phone:859-623-1950
Practice Address - Fax:859-623-0619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-01
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY5982Medicare PIN