Healthcare Provider Details

I. General information

NPI: 1710211941
Provider Name (Legal Business Name): KEITH SINCLAIR MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2009
Last Update Date: 12/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 IMAGING DR
SOMERSET KY
42503-2869
US

IV. Provider business mailing address

225 NESMIN LN
SOMERSET KY
42503-5659
US

V. Phone/Fax

Practice location:
  • Phone: 606-305-8022
  • Fax: 866-249-9994
Mailing address:
  • Phone: 606-416-7485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number28427
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateNULL
# 5
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number28427
License Number StateKY

VIII. Authorized Official

Name: KEITH SINCLAIR
Title or Position: OWNER
Credential: M.D.
Phone: 606-305-8022