1134267594 NPI number — ST. CLAIRE MEDICAL CENTER INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134267594 NPI number — ST. CLAIRE MEDICAL CENTER INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. CLAIRE MEDICAL CENTER INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ST. CLAIRE REGIONAL FAMILY MEDICINE-SANDY HOOK
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134267594
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 748
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANDY HOOK
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41171-0748
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-738-5155
Provider Business Mailing Address Fax Number:
606-738-5420

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
390 KY HWY 7 SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANDY HOOK
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41171
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-738-5155
Provider Business Practice Location Address Fax Number:
606-738-5420
Provider Enumeration Date:
02/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LLOYD
Authorized Official First Name:
DONALD
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PRESIDENT - CEO
Authorized Official Telephone Number:
606-783-6502

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , with the licence number:  900058 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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