Southeastern Medical Group, LLC

Primary specialty

SpecialistTaxonomy code 174400000X

License

17764 Issued in SC

Legal business name

SOUTHEASTERN MEDICAL GROUP, LLC

Practice address

609 South Lake Dr
Ste 1
Lexington, SC 29072-4119

Phone

(803) 957-0770

Fax

(803) 957-0909

NPI assigned

Jul 29, 2006

Last updated

May 21, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Nowamagbe A Omoigui, MD

Title

Physician

Phone

(803) 957-0770

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

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

{
    "created_epoch": "1154131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1590019200000",
    "number": "1093729386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "609 SOUTH LAKE DR",
            "address_2": "STE 1",
            "city": "LEXINGTON",
            "state": "SC",
            "postal_code": "290724119",
            "telephone_number": "803-957-0770",
            "fax_number": "803-957-0909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "609 SOUTH LAKE DR",
            "address_2": "STE 1",
            "city": "LEXINGTON",
            "state": "SC",
            "postal_code": "290724119",
            "telephone_number": "803-957-0770",
            "fax_number": "803-957-0909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-29",
        "last_updated": "2020-05-21",
        "status": "A",
        "authorized_official_last_name": "OMOIGUI",
        "authorized_official_first_name": "NOWAMAGBE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "803-957-0770",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "SC",
            "license": "17764",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DR. OMOIGUI SSN",
            "identifier": "$$$$$$$$$",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DR. OMOIGUI IND NPI #",
            "identifier": "1386645596",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SC MEDICAL LICENSE #",
            "identifier": "17764",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Lexington, SC
• Providers in Lexington, SC by specialty
• Specialist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2020; 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.