1134180920 NPI number — ST. CLAIRE MEDICAL CENTER, INC

Table of content: (NPI 1134180920)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134180920 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:
Provider Other Organization Name Type Code:
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:
1134180920
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 1120
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OWINGSVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40360-1120
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-674-6386
Provider Business Mailing Address Fax Number:
606-674-3096

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
632 SLATE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OWINGSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40360-2206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-674-6386
Provider Business Practice Location Address Fax Number:
606-674-3096
Provider Enumeration Date:
03/31/2006

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: 261QP2300X , with the licence number:  700048 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR1300X , with the licence number: 900056 , 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: 080104514 . This is a "RAILROAD MEDICARE INDIV #" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7100335590 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 020915100 . This is a "FEDERAL BLACK LUNG" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: CEO156 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 080020948 . This is a "RAILROAD MEDICARE INDIV #" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 31000599 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 080020949 . This is a "RAILROAD MEDICARE INDIV #" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 080113231 . This is a "RAILROAD MEDICARE INDIV #" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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