Clinton Shain Kiteck, D.O.
Individual provider Active NPI Family Medicine Physician · Columbia, KY
NPI 1447437116 · NPPES record last updated Mar 2, 2023
Key facts
- NPI
- 1447437116
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 03065 (KY)
- Practice address
- 810 Jamestown St
Columbia, KY 42728-1010 - Phone
- (270) 384-4764
- Fax
- (270) 384-6228
- NPI assigned
- Jan 24, 2008
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 25
Hospital & facility affiliations 5
Owned or controlled facilities with NPI records 1
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- University of Pikeville, Kentucky College of Osteopathic Med, 2005
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Adair County Hospital District
T J Health Columbia Inc
Kentucky Orthopedic Rehabilitation LLC
Practice addresses (Care Compare)
810 Jamestown St
Columbia, KY 42728-1010
930 Jamestown St
Columbia, KY 42728-1012
Phone (270) 751-8730
Hospital & facility affiliations
- TJ Health Columbia
- Taylor Regional Hospital
- T J Samson Community Hospital
- Russell County Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| T J Health Greensburg Clinic |
Rural health clinic | W-2 Managing Employee | Jan 1, 2024 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080827000344 | KY | Practitioner - Family Practice | 7416023429 | Reassigns benefits to 5 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy, Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| T J Health Columbia Inc | Current |
Accepting new patients | |
| T J Health Columbia Inc | Current | Accepting new patients | |
| T J Health Columbia Inc | Current | Accepting new patients | |
| T J Health Columbia Inc | Current |
Accepting new patients | |
| T J Health Columbia Inc | Current |
Accepting new patients | |
| T J Health Columbia Inc | Current |
Accepting new patients | |
| T J Health Columbia Inc | Current |
Accepting new patients | |
| T J Health Columbia Inc | Current |
Accepting new patients |
Locations
810 Jamestown St
Columbia, KY 42728
Phone (270) 384-4764
902 Wellness Way
Columbia, KY 42728
Phone (270) 384-0451
901 Wellness Way
Columbia, KY 42728
Phone (270) 384-4753
1704 W Stockton St
Edmonton, KY 42129
Phone (270) 432-3111
310 N L Rogers Wells Blvd
Glasgow, KY 42141
Phone (270) 651-1111
1301 N Race St
Glasgow, KY 42141
Phone (270) 651-4141
603 Columbia Hwy
Greensburg, KY 42743
Phone (270) 932-4518
542 Steve Dr
Russell Springs, KY 42642
Phone (270) 858-3636
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 03065 | KY | Yes |
Addresses
Primary practice location
810 Jamestown St
Columbia, KY 42728-1010
Mailing address
810 Jamestown St
Columbia, KY 42728-1010
Phone (270) 384-4764
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7100058480 | Medicaid | KY |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | ckiteck@tjrh.cernerdirect.com |
Other providers in Columbia, KY
- Kentucky Orthopedic Rehabilitation, LLC
- Kerr Eye Care PLLC
- Crystal Kimbler
- Pamela K King
- Yuichi Kitagawa
- Jerry William Knifley
- Ashley B Knopp
- Kiyomasa Komatsu
- Muharem Komic
- Jessica Lacy
All providers in Columbia, KY · Family Medicine Physician in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 2, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.