Organization
PATTIE A CLAY INFIRMARY ASSN.
Active
Other names
Pattie A. Clay Internal Medicine-Gina D'Costa MD
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WENDELL C MCCLURG (CFO)
(859) 624-0012
Entity
Organization
Contact information
Practice address
789 EASTERN BYP, SUITE 11, RICHMOND, KY 40475-2415
(859) 624-0012
(859) 624-0899
Mailing address
789 EASTERN BYP, SUITE 11, RICHMOND, KY 40475-2415
(859) 624-0012
(859) 624-0899
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
—
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64094576
—
KY
Enumeration date
02/21/2012
Last updated
02/21/2012
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