SE Costal Laser Services, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

SE COSTAL LASER SERVICES, LLC

Practice address

2351 College Station Rd
Athens, GA 30605-3619

Phone

(520) 547-4130

Fax

(520) 258-0304

NPI assigned

Jan 31, 2008

Last updated

Jun 6, 2008By 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

Mary Ann Evanoski

Title

Billing Manager

Phone

(520) 547-4130

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1201737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212710400000",
    "number": "1215115316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6339 E SPEEDWAY BLVD",
            "address_2": "SUITE 201",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857101147",
            "telephone_number": "520-547-4130",
            "fax_number": "520-258-0304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2351 COLLEGE STATION RD",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306053619",
            "telephone_number": "520-547-4130",
            "fax_number": "520-258-0304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SE COSTAL LASER SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-31",
        "last_updated": "2008-06-06",
        "status": "A",
        "authorized_official_last_name": "EVANOSKI",
        "authorized_official_first_name": "MARY ANN",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "520-547-4130"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Ambulatory Surgical Clinic/Center in Athens, GA
• Providers in Athens, GA by specialty
• Ambulatory Surgical Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2008; 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.