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Organization

SOUTHEND GASTROENTEROLOGY ASSOCIATES PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
SANJAY K JAIN MD (OWNER)
(502) 891-4000
Entity
Organization

Contact information

Practice address
4402 CHURCHMAN AVE, STE 408, LOUISVILLE, KY 40215-1190
(502) 365-5140
Mailing address
2503 BUSH RIDGE DR, A, LOUISVILLE, KY 40245-5885
(502) 819-4000

Taxonomy

Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000644156
ANTHEM
05
201118680
IN
01
50027327
PASSPORT
KY
05
7100101260
KY
01
7956992
AETNA
Enumeration date
12/16/2009
Last updated
05/17/2019
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