Organization
CLARK REGIONAL MEDICAL CENTER, INC
Active
Other names
Powell County Clinic 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
68 EAST ELKINS STREET, STANTON, KY 40380-0190
(606) 663-4758
(606) 663-8034
Mailing address
1107 W LEXINGTON AVE, WINCHESTER, KY 40391-0950
(606) 663-4758
(606) 663-8034
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
100874
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000054543
BLUE CROSS
KY
05
—
01007335
—
KY
01
—
032043100
BLACK LUNG
KY
Enumeration date
07/14/2006
Last updated
05/20/2010
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