| Organization Name: | ST. MICHAEL'S HEALTH CLINIC |
| NPI Number: | 1366800922 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KIMBERLY RIDDLE (DNP, APRN) |
| Mailing Address: | 2801 Walter Garrett Ln Oak Grove |
| State: | KY US |
| Postal Code: | 422629998 |
| Phone Number: | 2706405821 |
| Fax Number: | 8442705587 |
| NPI Enumeration Date: | 02/10/2016 |
| NPI Last Update Date: | 03/30/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | 3004526 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KY |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |