Provider Demographics
NPI:1326009044
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 1:316 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:606-784-3771
Mailing Address - Fax:606-783-6847
Practice Address - Street 1:316 W 2ND ST
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-1550
Practice Address - Country:US
Practice Address - Phone:606-784-3771
Practice Address - Fax:606-783-6847
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
1041C0700X, 363A00000X
KY1223G0001X, 207Q00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY080113228OtherRAILROAD MEDICARE INDIV #
KY080113327OtherRAILROAD MEDICARE/INDIV #
KY65911273Medicaid
KY080096401OtherMEDICARE RAILROAD INDIV #
KY7100246540Medicaid
KY7100631380Medicaid
KY31000326Medicaid
KY020331700OtherFEDERAL BLACK LUNG
KY420000377OtherRAILROAD MEDICARE INDIV #
KY7100246560Medicaid
KY7100194420Medicaid
KY970021336OtherRAILROAD MEDICARE INDIV #
KY2133OtherMEDICARE PTAN
KY080113228OtherRAILROAD MEDICARE INDIV #
KY0213342Medicare ID - Type UnspecifiedINDV.#
KY0213319Medicare ID - Type UnspecifiedINDV.#
KY0213340Medicare ID - Type UnspecifiedINDV.#
KYDE7231Medicare ID - Type UnspecifiedRAILROAD MEDICARE
KY0213325Medicare ID - Type UnspecifiedINDV.#