Healthcare Provider Details

I. General information

NPI: 1639131527
Provider Name (Legal Business Name): ST. CLAIRE MEDICAL CENTER,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 08/17/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 BRICKLAYER STREET
OLIVE HILL KY
41164
US

IV. Provider business mailing address

PO BOX 1268
OLIVE HILL KY
41164-1268
US

V. Phone/Fax

Practice location:
  • Phone: 606-286-4152
  • Fax: 606-283-2385
Mailing address:
  • Phone: 606-286-4152
  • Fax: 606-286-2385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number700050
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number900057
License Number StateKY

VIII. Authorized Official

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