Healthcare Provider Details

I. General information

NPI: 1043736135
Provider Name (Legal Business Name): ST. CLAIRE MEDICAL CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2017
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 OLD VIKING DR
MOREHEAD KY
40351
US

IV. Provider business mailing address

255 OLD VIKING DR
MOREHEAD KY
40351-7579
US

V. Phone/Fax

Practice location:
  • Phone: 606-784-2774
  • Fax: 606-780-1118
Mailing address:
  • Phone: 606-784-2774
  • Fax: 606-780-1118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA417
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. DONALD H LLOYD II
Title or Position: PRESIDENT/CEO
Credential:
Phone: 606-783-6502