Provider Demographics
NPI:1760477848
Name:ST. CLAIRE MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:ST. CLAIRE MEDICAL CENTER, INC
Other - Org Name:ST. CLAIRE HOMECARE/HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
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 1:135 N HARGIS AVE
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-1676
Mailing Address - Country:US
Mailing Address - Phone:606-784-8403
Mailing Address - Fax:606-783-6822
Practice Address - Street 1:135 N HARGIS AVE
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-1676
Practice Address - Country:US
Practice Address - Phone:606-784-8403
Practice Address - Fax:606-783-6822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-15
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY150032251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY44103018Medicaid
KYXXXXXXXXXOtherHH, AETNA
KY00000005416OtherHH, BCBS
KY538022OtherHH, UNITED HEALTH CARE
KY006895400OtherHH, BLACK LUNG
KY4564OtherHH, CHA
KY45344389Medicaid
KY34011031Medicaid
KY=========OtherHH, VA
KYXXXXXXXXXOtherHH, AETNA