Southeastern Osteoporosis Services Inc

Primary specialty

Bone Densitometry Radiologic TechnologistTaxonomy code 2471B0102X

License

JR3419100 Issued in FL

Legal business name

SOUTHEASTERN OSTEOPOROSIS SERVICES INC

Practice address

4511 N Davis Hwy
Suite 1-C
Pensacola, FL 32503-2720

Phone

(850) 477-0775

NPI assigned

Aug 17, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Stephen D Bast, P.A.-C.

Title

President

Phone

(850) 477-0775

Specialties & licenses 1

Addresses

Other identifiers 2

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jennifer Lynn Richardson, P.A.-C

  • Medical Physician Assistant
  • Pensacola, FL
  • NPI 1699767384
  NPD (past)

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

{
    "created_epoch": "1124236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1407848211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4511 N DAVIS HWY",
            "address_2": "SUITE 1-C",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325032720",
            "telephone_number": "850-477-0775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4511 N DAVIS HWY",
            "address_2": "SUITE 1-C",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325032720",
            "telephone_number": "850-477-0775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN OSTEOPOROSIS SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BAST",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "850-477-0775",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "P.A.-C."
    },
    "taxonomies": [
        {
            "code": "2471B0102X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiologic Technologist, Bone Densitometry",
            "state": "FL",
            "license": "JR3419100",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE",
            "identifier": "3405722",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34252",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Phokham Mike Sourivanh, PA-C
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• Southeast Vascular Group LP
• Southeast Vascular Group LP
• Southern Dental Associates, P.a.
• Southern Family Markets LLC (Food World Pharmacy)
• Southern Home Care Services, Inc. (ResCare HomeCare)
• Southern Oaks Facility Inc (Southern Oaks Care Center)
• Southern Oaks Nursing and Rehab LLC

• Radiologic Technologist in Pensacola, FL
• Providers in Pensacola, FL by specialty
• Radiologic Technologist in Florida

• 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.