Provider Demographics
NPI:1447212493
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:PO BOX 748
Mailing Address - Street 2:
Mailing Address - City:SANDY HOOK
Mailing Address - State:KY
Mailing Address - Zip Code:41171-0748
Mailing Address - Country:US
Mailing Address - Phone:606-738-5155
Mailing Address - Fax:606-738-5420
Practice Address - Street 1:390 KY HWY 7 SOUTH
Practice Address - Street 2:
Practice Address - City:SANDY HOOK
Practice Address - State:KY
Practice Address - Zip Code:41171
Practice Address - Country:US
Practice Address - Phone:606-738-5155
Practice Address - Fax:606-738-5420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-05
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY700049261QP2300X
KY900058261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100336300Medicaid
KY010065019OtherRAILROAD MEDICARE INDIV #
KY080069346OtherMEDICARE RAILROAD INDIV #
KY080113229OtherMEDICARE RAILROAD INDIV #
KY020912900OtherFEDERAL BLACK LUNG
KY080041750OtherMEDICARE RAILROAD INDIV #
KY31000581Medicaid
KY080113229OtherMEDICARE RAILROAD INDIV #
KYCN1069Medicare ID - Type UnspecifiedRAILROAD MEDICARE
KY080041750OtherMEDICARE RAILROAD INDIV #
KY0247240Medicare ID - Type UnspecifiedINDV. #
KY0247229Medicare ID - Type UnspecifiedINDV.#
KY0247228Medicare ID - Type UnspecifiedINDV. #
KY0247211Medicare ID - Type UnspecifiedINDV. #
KY0247246Medicare ID - Type UnspecifiedINDV. #
KY0247202Medicare ID - Type UnspecifiedINDV. #
KY8158Medicare ID - Type UnspecifiedGROUP #