1558383885 NPI number — ST CLAIRE MEDICAL CENTER, INC

Table of content: (NPI 1558383885)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558383885 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:
CAVE RUN SURGICAL SPECIALISTS
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:
1558383885
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:
245 FLEMINGSBURG RD
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:
40351-1015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-780-5500
Provider Business Mailing Address Fax Number:
606-783-7281

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
245 FLEMINGSBURG RD
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-780-5500
Provider Business Practice Location Address Fax Number:
606-783-7281
Provider Enumeration Date:
07/24/2006

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XX0005X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: 20216 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208600000X , with the licence number: 40472 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0129X , with the licence number: 20079 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208800000X , with the licence number: 24696 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208800000X , with the licence number: 39293 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0103X , with the licence number: 309 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 65942153 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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