Provider Demographics
NPI:1619229556
Name:KENT M. PATRICK, M.D., P.C.
Entity Type:Organization
Organization Name:KENT M. PATRICK, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:STEICHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-665-5105
Mailing Address - Street 1:2525 FOX RUN PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-5370
Mailing Address - Country:US
Mailing Address - Phone:605-260-2118
Mailing Address - Fax:605-260-2119
Practice Address - Street 1:2525 FOX RUN PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-5370
Practice Address - Country:US
Practice Address - Phone:605-260-2118
Practice Address - Fax:605-260-2119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-02
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty