Provider Demographics
NPI:1003862574
Name:SITHER, WILLIAM T (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:T
Last Name:SITHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 CANTERBURY CT
Mailing Address - Street 2:
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-2536
Mailing Address - Country:US
Mailing Address - Phone:502-348-7655
Mailing Address - Fax:
Practice Address - Street 1:4305 NEW SHEPHERDSVILLE RD
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-9019
Practice Address - Country:US
Practice Address - Phone:502-348-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30731207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89132U6Medicaid
NC132U6OtherBCBS
SCQ30731Medicaid
SCQ30731Medicaid
210477BMedicare ID - Type Unspecified
NC89132U6Medicaid