Provider Demographics
NPI:1013030618
Name:SOUTHERN INDIANA ENT, LLC
Entity Type:Organization
Organization Name:SOUTHERN INDIANA ENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER-PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:D
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-376-3071
Mailing Address - Street 1:1655 N GLADSTONE AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-5392
Mailing Address - Country:US
Mailing Address - Phone:812-376-3071
Mailing Address - Fax:812-378-5721
Practice Address - Street 1:1655 N GLADSTONE AVE
Practice Address - Street 2:SUITE E
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-5392
Practice Address - Country:US
Practice Address - Phone:812-376-3071
Practice Address - Fax:812-378-5721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200337430Medicaid
IN200337430Medicaid