Provider Demographics
NPI:1679784433
Name:SELLERSBURG PEDIATRICS LLC
Entity type:Organization
Organization Name:SELLERSBURG PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:HENSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-246-0705
Mailing Address - Street 1:1730 WILLIAMSBURG DRIVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-8065
Mailing Address - Country:US
Mailing Address - Phone:812-246-0705
Mailing Address - Fax:812-246-0710
Practice Address - Street 1:1730 WILLIAMSBURG DRIVE
Practice Address - Street 2:SUITE 3
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-8065
Practice Address - Country:US
Practice Address - Phone:812-246-0705
Practice Address - Fax:812-246-0710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01043740A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200221960AMedicaid