1194765792 NPI number — ST. CLAIRE MEDICAL CENTER, INC.

Table of content: (NPI 1194765792)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194765792 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 HOME CARE/HOSPICE
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:
1194765792
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:
201 LYONS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOREHEAD
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40351-1143
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-783-6308
Provider Business Mailing Address Fax Number:
606-783-6906

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 LYONS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOREHEAD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40351-1143
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-784-6086
Provider Business Practice Location Address Fax Number:
606-783-6906
Provider Enumeration Date:
06/08/2006

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: 251G00000X , with the licence number:  400008 , 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)

  • Identifier: 000000327680 . This is a "BCBS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 44103018 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000054614 . This is a "BCBS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".