Basic Information
| Provider Information | |||||||||
| NPI: | 1376680751 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ST. CLAIRE MEDICAL CENTER, INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | ST. CLAIRE REGIONAL FAMILY MEDICINE-OWINGSVILLE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 968 | ||||||||
| Address2: | |||||||||
| City: | MOREHEAD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 403510968 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6067836521 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 632 SLATE AVE. | ||||||||
| Address2: | |||||||||
| City: | OWINGSVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 403601120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6066746386 | ||||||||
| FaxNumber: | 6066743096 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2007 | ||||||||
| LastUpdateDate: | 06/28/2019 | ||||||||
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| AuthorizedOfficialLastName: | LLOYD | ||||||||
| AuthorizedOfficialFirstName: | DONALD | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT - CEO | ||||||||
| AuthorizedOfficialTelephone: | 6067836501 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | II | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | 900056 | KY | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.