Provider Demographics
NPI:1922371988
Name:PATTIE A CLAY INFIRMARY ASSN.
Entity type:Organization
Organization Name:PATTIE A CLAY INFIRMARY ASSN.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:WENDELL
Authorized Official - Middle Name:C
Authorized Official - Last Name:MCCLURG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-624-0012
Mailing Address - Street 1:789 EASTERN BYP
Mailing Address - Street 2:SUITE 11
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-2415
Mailing Address - Country:US
Mailing Address - Phone:859-624-0012
Mailing Address - Fax:859-624-0899
Practice Address - Street 1:789 EASTERN BYP
Practice Address - Street 2:SUITE 11
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2415
Practice Address - Country:US
Practice Address - Phone:859-624-0012
Practice Address - Fax:859-624-0899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64094576Medicaid