Basic Information
| Provider Information | |||||||||
| NPI: | 1326009044 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ST. CLAIRE MEDICAL CENTER, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 316 W 2ND ST | ||||||||
| Address2: | |||||||||
| City: | MOREHEAD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 403511550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6067843771 | ||||||||
| FaxNumber: | 6067836847 | ||||||||
| Practice Location | |||||||||
| Address1: | 316 W 2ND ST | ||||||||
| Address2: | |||||||||
| City: | MOREHEAD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 403511550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6067843771 | ||||||||
| FaxNumber: | 6067836847 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2006 | ||||||||
| LastUpdateDate: | 04/07/2022 | ||||||||
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| AuthorizedOfficialLastName: | LLOYD | ||||||||
| AuthorizedOfficialFirstName: | DONALD | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 6067843771 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | II | ||||||||
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| NPICertificationDate: | 04/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1223G0001X | KY | N | 193200000X MULTI-SPECIALTY GROUP | Dental Providers | Dentist | General Practice | 363A00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363L00000X | KY | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 207Q00000X | KY | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 65911273 | 05 | KY | MEDICAID | 7100246540 | 05 | KY | MEDICAID | 7100194420 | 05 | KY | MEDICAID | 420000377 | 01 | KY | RAILROAD MEDICARE INDIV # | OTHER | 080113327 | 01 | KY | RAILROAD MEDICARE/INDIV # | OTHER | 7100246560 | 05 | KY | MEDICAID | 020331700 | 01 | KY | FEDERAL BLACK LUNG | OTHER | 7100631380 | 05 | KY | MEDICAID | 080113228 | 01 | KY | RAILROAD MEDICARE INDIV # | OTHER | 2133 | 01 | KY | MEDICARE PTAN | OTHER | 31000326 | 05 | KY | MEDICAID | 080096401 | 01 | KY | MEDICARE RAILROAD INDIV # | OTHER | 970021336 | 01 | KY | RAILROAD MEDICARE INDIV # | OTHER |