Provider Demographics
NPI: | 1821168535 |
---|---|
Name: | ST CLAIRE MEDICAL CENTER, INC., |
Entity Type: | Organization |
Organization Name: | ST CLAIRE MEDICAL CENTER, INC., |
Other - Org Name: | ST CLAIRE REGIONAL MEDICAL CENTER |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CEO/PRESIDENT |
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: | 222 MEDICAL CIR |
Mailing Address - Street 2: | |
Mailing Address - City: | MOREHEAD |
Mailing Address - State: | KY |
Mailing Address - Zip Code: | 40351-1179 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 606-783-6500 |
Mailing Address - Fax: | 606-783-6904 |
Practice Address - Street 1: | 222 MEDICAL CIR |
Practice Address - Street 2: | |
Practice Address - City: | MOREHEAD |
Practice Address - State: | KY |
Practice Address - Zip Code: | 40351-1179 |
Practice Address - Country: | US |
Practice Address - Phone: | 606-783-6500 |
Practice Address - Fax: | 606-783-6904 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | ST CLAIRE MEDICAL CENTER, INC., |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2006-11-09 |
Last Update Date: | 2023-08-17 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
1223S0112X, 208200000X | ||
KY | 100377 | 207L00000X, 207Q00000X, 207R00000X, 207RN0300X, 207RP1001X, 207V00000X, 207ZC0500X, 207ZP0102X, 208100000X, 282N00000X, 363A00000X, 363LF0000X, 367500000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 282N00000X | Hospitals | General Acute Care Hospital | Group - Single Specialty | |
No | 1223S0112X | Dental Providers | Dentist | Oral and Maxillofacial Surgery | Group - Single Specialty |
No | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | Group - Single Specialty | |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Single Specialty | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Single Specialty | |
No | 207RN0300X | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | Group - Single Specialty |
No | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | Group - Single Specialty |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Single Specialty | |
No | 207ZC0500X | Allopathic & Osteopathic Physicians | Pathology | Cytopathology | Group - Single Specialty |
No | 207ZP0102X | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | Group - Single Specialty |
No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Single Specialty | |
No | 208200000X | Allopathic & Osteopathic Physicians | Plastic Surgery | Group - Single Specialty | |
No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Single Specialty | |
No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Single Specialty |
No | 367500000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | Group - Single Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
KY | 7100045200 | Medicaid | |
KY | 7890439800 | Medicaid | |
KY | 9590110400 | Medicaid | |
KY | 7490073900 | Medicaid | |
KY | 6590684400 | Medicaid | |
KY | 7490073900 | Medicaid |