Provider Demographics
NPI:1841334570
Name:ST CLAIRE REGIONAL MEDICAL CENTER
Entity type:Organization
Organization Name:ST CLAIRE REGIONAL MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
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: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:
Mailing Address - Fax:
Practice Address - Street 1:632 SLATE AVE
Practice Address - Street 2:
Practice Address - City:OWINGSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40360
Practice Address - Country:US
Practice Address - Phone:606-674-6177
Practice Address - Fax:606-674-3096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPO14133336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY5401692800Medicaid
1813256OtherOTHER ID NUMBER
1813256OtherOTHER ID NUMBER-COMMERCIAL NUMBER
KY9003006500Medicaid
KY9003006500Medicaid