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Organization

KENTUCKY HOSPITAL, LLC

Active
Other names
Clark Regional Medical Center
Organization subpart
No

Provider details

NPI number
Authorized official
MR. ROBERT DONALD FRARACCIO (CHIEF EXECUTIVE OFFICER)
(859) 745-3500
Entity
Organization

Contact information

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

Taxonomy

Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000061940
ANTHEM BLUE CROSS BLUE SHIELD
KY
01
000000657636
ANTHEM BLUE CROSS BLUE SHEILD REFERENCE LAB
KY
Enumeration date
05/19/2008
Last updated
05/26/2010
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