Basic Information
Provider Information
NPI: 1134180920
EntityType: 2
ReplacementNPI:  
OrganizationName: ST. CLAIRE MEDICAL CENTER, INC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 1120
Address2:  
City: OWINGSVILLE
State: KY
PostalCode: 403601120
CountryCode: US
TelephoneNumber: 6066746386
FaxNumber: 6066743096
Practice Location
Address1: 632 SLATE AVE
Address2:  
City: OWINGSVILLE
State: KY
PostalCode: 403602206
CountryCode: US
TelephoneNumber: 6066746386
FaxNumber: 6066743096
Other Information
ProviderEnumerationDate: 03/31/2006
LastUpdateDate: 04/07/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: LLOYD
AuthorizedOfficialFirstName: DONALD
AuthorizedOfficialMiddleName: H
AuthorizedOfficialTitleorPosition: PRESIDENT/CEO
AuthorizedOfficialTelephone: 6067836501
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix: II
AuthorizedOfficialCredential:  
NPICertificationDate: 04/07/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QP2300X700048KYN Ambulatory Health Care FacilitiesClinic/CenterPrimary Care
261QR1300X900056KYY Ambulatory Health Care FacilitiesClinic/CenterRural Health

ID Information
IDTypeStateIssuerDescription
08002094901KYRAILROAD MEDICARE INDIV #OTHER
CEO15601 MEDICARE RAILROADOTHER
08011323101KYRAILROAD MEDICARE INDIV #OTHER
08002094801KYRAILROAD MEDICARE INDIV #OTHER
02091510001KYFEDERAL BLACK LUNGOTHER
08010451401KYRAILROAD MEDICARE INDIV #OTHER
710033559005KY MEDICAID
3100059905KY MEDICAID


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