Active NPI
Vidalia Pulmonology Center, LLC
- Pulmonary Disease Physician
- Vidalia, GA
National Provider Identifier
1194985093
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pulmonary Disease Physician
- Legal business name
- VIDALIA PULMONOLOGY CENTER, LLC
- Practice address
- 1811 Edwina Dr
Vidalia, GA 30474-8963 - Phone
- (912) 538-8105
- Fax
- (912) 538-8109
- NPI assigned
- Jun 13, 2008
- Last updated
- May 29, 2014
- Organization subpart
- Yes
- Parent organization
- SOUTHEAST REGIONAL PRIMARY CARE CORPORATION
NPPES NPI Registry
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) 538-5314
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Critical Care Medicine (Internal Medicine) Physician | 207RC0200X | |||
| Pulmonary Disease Physician | 207RP1001X | Primary | ||
| Sleep Medicine (Internal Medicine) Physician | 207RS0012X |
Addresses
Primary practice location
1811 Edwina Dr
Vidalia, GA 30474-8963
Mailing address
PO Box 407
Vidalia, GA 30475-0407
Phone (912) 538-8105
National Provider Directory
National Provider Directory- Part of
- Southeast Regional Primary Care Corporation
Interoperability endpoints
- debra.durden@vpc.gadirect.net
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1213315200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1401321600000",
"number": "1194985093",
"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",
"telephone_number": "912-538-8105",
"fax_number": "912-538-8109"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1811 EDWINA DR",
"city": "VIDALIA",
"state": "GA",
"postal_code": "304748963",
"telephone_number": "912-538-8105",
"fax_number": "912-538-8109"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "VIDALIA PULMONOLOGY CENTER, LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "SOUTHEAST REGIONAL PRIMARY CARE CORPORATION",
"enumeration_date": "2008-06-13",
"last_updated": "2014-05-29",
"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": "912-538-5314"
},
"taxonomies": [
{
"code": "207RC0200X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Internal Medicine, Critical Care Medicine",
"state": null,
"license": null,
"primary": false
},
{
"code": "207RP1001X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Internal Medicine, Pulmonary Disease",
"state": null,
"license": null,
"primary": true
},
{
"code": "207RS0012X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Internal Medicine, Sleep Medicine",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vidalia, GA
- Vidalia OB GYN
- Vidalia Open MRI, LLC
- Vidalia Oral and Maxillofacial Surgery, P.C.
- Vidalia Orthopedic Center, LLC
- Vidalia Pharmacy Inc
- Vidalia Radiology Associates
- Vidalia Regional Cancer Center
- Vidalia Surgical Associates, LLC
- Vidalia Urology Associates, LLC
- Vidalia Women's Center, LLC (Vidalia Women's Center)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.