Clark Regional Medical Center, Inc

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

100874 Issued in KY

Legal business name

CLARK REGIONAL MEDICAL CENTER, INC

Doing business as

Powell County Clinic Rehabilitation

Practice address

68 East Elkins Street
Stanton, KY 40380-0190

Phone

(606) 663-4758

Fax

(606) 663-8034

NPI assigned

Jul 14, 2006

Last updated

May 20, 2010By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Robert D Fraraccio

Title

Chief Financial Officer

Phone

(859) 745-3500

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Powell County Clinic Rehabilitation Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1274313600000",
    "number": "1811913668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1107 W LEXINGTON AVE",
            "city": "WINCHESTER",
            "state": "KY",
            "postal_code": "403910950",
            "telephone_number": "606-663-4758",
            "fax_number": "606-663-8034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "68 EAST ELKINS STREET",
            "city": "STANTON",
            "state": "KY",
            "postal_code": "403800190",
            "telephone_number": "606-663-4758",
            "fax_number": "606-663-8034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARK REGIONAL MEDICAL CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-14",
        "last_updated": "2010-05-20",
        "status": "A",
        "authorized_official_last_name": "FRARACCIO",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "859-745-3500",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "KY",
            "license": "100874",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01007335",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "000000054543",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLACK LUNG",
            "identifier": "032043100",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Powell County Clinic Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Troy David Brooks, P.A.
• Heather Leigh Burchett, PT
• Mary Etta Burrows, OT
• Rosemary Stuehler Capo, OT
• Casa San Pio Clinics of Appalachia, LLC
• Katherine Clevenger, LPCC
• James Lester Click, PT
• Wynonna Cline, LMT
• Laura Tipton Cockrell, PT
• Commonwealth Urology, PSC

• Physical Therapy Clinic/Center in Stanton, KY
• Providers in Stanton, KY by specialty
• Physical Therapy Clinic/Center in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.