Provider Demographics
NPI:1376680751
Name:ST. CLAIRE MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:ST. CLAIRE MEDICAL CENTER, INC
Other - Org Name:ST. CLAIRE REGIONAL FAMILY MEDICINE-OWINGSVILLE
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:PO BOX 968
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-0968
Mailing Address - Country:US
Mailing Address - Phone:606-783-6521
Mailing Address - Fax:
Practice Address - Street 1:632 SLATE AVE.
Practice Address - Street 2:
Practice Address - City:OWINGSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40360-1120
Practice Address - Country:US
Practice Address - Phone:606-674-6386
Practice Address - Fax:606-674-3096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY900056261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY183416Medicare Oscar/Certification