NPIMap

Organization Active NPI

Southeast Regional Primary Care Corporation

Doing business as Meadows Medical Group Internal Medicine

  • Internal Medicine Physician
  • Vidalia, GA
National Provider Identifier
1063914851
Registry record updated Dec 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
SOUTHEAST REGIONAL PRIMARY CARE CORPORATION
Doing business as
Meadows Medical Group Internal Medicine
Practice address
621 E 1St St Ste B
Vidalia, GA 30474-4264
Phone
(912) 535-5120
NPI assigned
Mar 7, 2018
Last updated
Dec 21, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tony M O'Steen
Title
Cfo
Phone
(912) 535-5560

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X NU Primary

Addresses

Primary practice location

621 E 1St St Ste B
Vidalia, GA 30474-4264

Mailing address

PO Box 407
Vidalia, GA 30475-0407

Other names 1

  • Meadows Medical Group Internal Medicine Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Southeast Regional Primary Care Corporation12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1520380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1545350400000",
    "number": "1063914851",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 407",
            "city": "VIDALIA",
            "state": "GA",
            "postal_code": "304750407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 E 1ST ST STE B",
            "city": "VIDALIA",
            "state": "GA",
            "postal_code": "304744264",
            "telephone_number": "912-535-5120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST REGIONAL PRIMARY CARE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-07",
        "last_updated": "2018-12-21",
        "status": "A",
        "authorized_official_last_name": "O'STEEN",
        "authorized_official_first_name": "TONY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "912-535-5560"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Meadows Medical Group Internal Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Vidalia, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.