NPIMap

Organization Active NPI

Southeastern Overread Services, PLLC

  • Body Imaging Physician
  • Greensboro, NC
National Provider Identifier
1124060678
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Body Imaging PhysicianTaxonomy code 2085B0100X
Legal business name
SOUTHEASTERN OVERREAD SERVICES, PLLC
Practice address
3723 W Market St
Suite a
Greensboro, NC 27403-1590
Phone
(336) 852-3488
Fax
(336) 852-3442
NPI assigned
Jun 11, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dallas A Smith Jr., MDNPI 1972507655
Title
President
Phone
(336) 852-3488

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Body Imaging PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085B0100X Primary

Addresses

Primary practice location

3723 W Market St
Suite a
Greensboro, NC 27403-1590

Mailing address

PO Box 16566
Chapel Hill, NC 27516-6566
Phone (919) 967-6646

Other identifiers 2

IdentifierTypeStateIssuer
013TROtherNCBLUE CROSS/BLUE SHIELD
89013TRMedicaidNC

National Provider Directory

National Provider Directory

Locations

3723 W Market St
Ste A
Greensboro, NC 27403
Phone (336) 852-3488

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1149984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1124060678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 16566",
            "city": "CHAPEL HILL",
            "state": "NC",
            "postal_code": "275166566",
            "telephone_number": "919-967-6646",
            "fax_number": "919-967-6647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3723 W MARKET ST",
            "address_2": "SUITE A",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274031590",
            "telephone_number": "336-852-3488",
            "fax_number": "336-852-3442"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN OVERREAD SERVICES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "DALLAS",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "336-852-3488",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085B0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Body Imaging",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "013TR",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89013TR",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greensboro, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.