Provider Demographics
NPI:1457642225
Name:SYDNOR ENTERPRISES, LLC
Entity Type:Organization
Organization Name:SYDNOR ENTERPRISES, LLC
Other - Org Name:KENTUCKIANA MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:CLT(C)
Authorized Official - Phone:270-495-9773
Mailing Address - Street 1:941 STATE ST
Mailing Address - Street 2:STE 2
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-4727
Mailing Address - Country:US
Mailing Address - Phone:270-495-9773
Mailing Address - Fax:
Practice Address - Street 1:701 EASTERN BLVD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47129-2338
Practice Address - Country:US
Practice Address - Phone:270-495-9773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty