Healthcare Provider Details

I. General information

NPI: 1922371988
Provider Name (Legal Business Name): PATTIE A CLAY INFIRMARY ASSN.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2012
Last Update Date: 02/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

789 EASTERN BYP SUITE 11
RICHMOND KY
40475-2415
US

IV. Provider business mailing address

789 EASTERN BYP SUITE 11
RICHMOND KY
40475-2415
US

V. Phone/Fax

Practice location:
  • Phone: 859-624-0012
  • Fax: 859-624-0899
Mailing address:
  • Phone: 859-624-0012
  • Fax: 859-624-0899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number StateKY

VIII. Authorized Official

Name: MR. WENDELL C MCCLURG
Title or Position: CFO
Credential:
Phone: 859-624-0012