Basic Information
| Provider Information | |||||||||
| NPI: | 1639364201 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PATTIE A. CLAY INFIRMARY ASSN | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 1600 | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | KY | ||||||||
| PostalCode: | 404762603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8596253299 | ||||||||
| FaxNumber: | 8596253535 | ||||||||
| Practice Location | |||||||||
| Address1: | 789 EASTERN BYP | ||||||||
| Address2: | SUITE 25 | ||||||||
| City: | RICHMOND | ||||||||
| State: | KY | ||||||||
| PostalCode: | 404752415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8596253299 | ||||||||
| FaxNumber: | 8596253535 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2007 | ||||||||
| LastUpdateDate: | 08/18/2010 | ||||||||
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| AuthorizedOfficialLastName: | OLDS | ||||||||
| AuthorizedOfficialFirstName: | PATRICIA | ||||||||
| AuthorizedOfficialMiddleName: | ANN | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8596253299 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | FACHE | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 100322 | KY | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 5771 | 01 | KY | MEDICARE GROUP | OTHER |