# CLARK REGIONAL MEDICAL CENTER, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053337881
- **Authorized official:** MR. ROBERT D FRARACCIO (CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (859) 745-3500

## Contact information

- **Practice address:** 1107 W LEXINGTON AVE, WINCHESTER, KY 40391-1169
- **Practice address phone:** (859) 745-3500
- **Practice address fax:** (859) 745-3450
- **Mailing address:** 1107 W LEXINGTON AVE, WINCHESTER, KY 40391-1169
- **Mailing address phone:** (859) 745-3500
- **Mailing address fax:** (859) 745-3450

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 100740 | KY | Yes |

## Other

- **Enumeration date:** 07/14/2006
- **Last updated:** 05/20/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000000054544 | BLUE CROSS | KY |
| 01 | — | 032043100 | BLACK LUNG | KY |
| 05 | — | 12503637 | — | KY |