Basic Information
| Provider Information | |||||||||
| NPI: | 1154349827 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTHERN INDIANA ANESTHESIA CONSULTANTS, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 70101 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402700101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026908782 | ||||||||
| FaxNumber: | 5024590923 | ||||||||
| Practice Location | |||||||||
| Address1: | 1850 STATE ST | ||||||||
| Address2: | |||||||||
| City: | NEW ALBANY | ||||||||
| State: | IN | ||||||||
| PostalCode: | 471504990 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026908782 | ||||||||
| FaxNumber: | 5024590923 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 12/13/2012 | ||||||||
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| AuthorizedOfficialLastName: | MILLER | ||||||||
| AuthorizedOfficialFirstName: | BARRY | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5026908782 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 207L00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 000000064676 | 01 | KY | ANTHEM | OTHER | 000000064676 | 01 | IN | ANTHEM | OTHER | 2441627000 | 01 | IN | PASSPORT ADVANTAGE | OTHER | 000000064676 | 01 | IN | HEALTHLINK | OTHER | 200230600A | 01 | IN | MANAGED HEALTH SERVICES | OTHER | 200230600A | 01 | IN | MDWISE HOOSIER ALLIANCE | OTHER | 000000064676 | 01 | IN | UNICARE | OTHER | 129703800 | 01 | IN | US DEPT OF LABOR | OTHER | 134960 | 01 | IN | UNICARE MEDICARE | OTHER | 000000064676 | 01 | IN | INDIANA COMPREHENSIVE | OTHER | 000000064676 | 01 | IN | ANTHEM MEDICAID | OTHER | CI9097 | 01 | IN | RAILROAD MEDICARE | OTHER | 000000064676 | 01 | IN | ONE NATION BENEFIT | OTHER | 129703800 | 01 | IN | BLACK LUNG PROGRAM | OTHER | 200230600A | 05 | IN | MEDICAID |