Organization
CLARK REGIONAL MEDICAL CENTER, INC
Active
Other names
Clark Immediate Care Center Rehabilitation
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT D FRARACCIO (CHIEF FINANCIAL OFFICER)
(859) 745-3500
Entity
Organization
Contact information
Practice address
1934 BYPASS RD, WINCHESTER, KY 40391-2389
(859) 745-0191
(859) 745-7789
Mailing address
1107 W LEXINGTON AVE, WINCHESTER, KY 40391-1169
(859) 745-3500
(859) 745-3450
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
100902
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000054543
BLUE CROSS
KY
05
—
01007335
—
KY
01
—
032043100
BLACK LUNG
KY
Enumeration date
07/17/2006
Last updated
05/20/2010
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