Provider Demographics
NPI:1134180920
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 1120
Mailing Address - Street 2:
Mailing Address - City:OWINGSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40360-1120
Mailing Address - Country:US
Mailing Address - Phone:606-674-6386
Mailing Address - Fax:606-674-3096
Practice Address - Street 1:632 SLATE AVE
Practice Address - Street 2:
Practice Address - City:OWINGSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40360-2206
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:2006-03-31
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY700048261QP2300X
KY900056261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY080104514OtherRAILROAD MEDICARE INDIV #
KY7100335590Medicaid
KY020915100OtherFEDERAL BLACK LUNG
CEO156OtherMEDICARE RAILROAD
KY080020948OtherRAILROAD MEDICARE INDIV #
KY31000599Medicaid
KY080020949OtherRAILROAD MEDICARE INDIV #
KY080113231OtherRAILROAD MEDICARE INDIV #
KY1063331Medicare PIN
KY1063342Medicare PIN
KY080020948OtherRAILROAD MEDICARE INDIV #
KY1063370Medicare PIN
KY1063304Medicare PIN
KY080020949OtherRAILROAD MEDICARE INDIV #
KY0633Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
KY080113231OtherRAILROAD MEDICARE INDIV #
CEO156OtherMEDICARE RAILROAD
KY1063363Medicare PIN
KY31000599Medicaid