Provider Demographics
NPI:1265493993
Name:ST. CLAIRE MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:ST. CLAIRE MEDICAL CENTER, INC
Other - Org Name:
Other - Org Type:
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 1:732 HIGHWAY 36
Mailing Address - Street 2:
Mailing Address - City:FRENCHBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40322-8123
Mailing Address - Country:US
Mailing Address - Phone:606-768-2191
Mailing Address - Fax:606-768-6130
Practice Address - Street 1:732 HIGHWAY 36
Practice Address - Street 2:
Practice Address - City:FRENCHBURG
Practice Address - State:KY
Practice Address - Zip Code:40322-8123
Practice Address - Country:US
Practice Address - Phone:606-768-2191
Practice Address - Fax:606-768-6130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY700033261QP2300X
KY900059261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY080025861OtherRAILROAD MEDICARE INDIV #
KY021060400OtherFEDERAL BLACK LUNG
KY7100336290Medicaid
KY080099911OtherRAILROAD MEDICARE INDIV #
KY080113233OtherRAILROAD MEDICARE INDIV #
KY31000607Medicaid
KYP00196323OtherRAILROAD MEDICARE INDIV #
KY8002OtherPTAN
KY31000607Medicaid
KY021060400OtherFEDERAL BLACK LUNG
KY0074267Medicare ID - Type UnspecifiedINDV.#
KY080025861OtherRAILROAD MEDICARE INDIV #
KY0014266Medicare ID - Type UnspecifiedINDV.#
KYDC7339Medicare ID - Type UnspecifiedMEDICARE RAILROAD
KYP00196323OtherRAILROAD MEDICARE INDIV #
KY0213337Medicare ID - Type UnspecifiedINDV.#
KY0074252Medicare ID - Type UnspecifiedINDV.#