1760477848 NPI number — ST. CLAIRE MEDICAL CENTER, INC

Table of content: (NPI 1760477848)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760477848 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:
6
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:
1760477848
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:
135 N HARGIS 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:
40351-1676
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-784-8403
Provider Business Mailing Address Fax Number:
606-783-6822

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
135 N HARGIS 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:
40351-1676
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-784-8403
Provider Business Practice Location Address Fax Number:
606-783-6822
Provider Enumeration Date:
09/15/2005

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: 251E00000X , with the licence number:  150032 , 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: 44103018 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: XXXXXXXXX . This is a "HH, AETNA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 00000005416 . This is a "HH, BCBS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 538022 . This is a "HH, UNITED HEALTH CARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 006895400 . This is a "HH, BLACK LUNG" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 4564 . This is a "HH, CHA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 45344389 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 34011031 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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