NPIMap

Organization Active NPI

Southeast Regional Primary Care Corporation

  • Multi-Specialty Clinic/Center
  • Vidalia, GA
National Provider Identifier
1467568907
Registry record updated Mar 13, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
SOUTHEAST REGIONAL PRIMARY CARE CORPORATION
Practice address
One Meadows Parkway
Vidalia, GA 30474-8921
Phone
(912) 535-3011
Fax
(912) 537-5366
NPI assigned
Aug 21, 2006
Last updated
Mar 13, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2019

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

Authorized official

Name
Tony M Osteen
Title
Cfo
Phone
(912) 535-8691

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X GA
Multi-Specialty Clinic/Center 261QM1300X Primary
Primary Care Clinic/Center 261QP2300X
Radiology Clinic/Center 261QR0200X
Sleep Disorder Diagnostic Clinic/Center 261QS1200X

Addresses

Primary practice location

One Meadows Parkway
Vidalia, GA 30474-8921

Mailing address

PO Box 407
Vidalia, GA 30475-0407
Phone (912) 535-3011

Other practice location 1

621 E 1st St Ste B
Vidalia, GA 30474-4264
Phone (912) 535-5555

Other practice location 2

1707 Meadows Ln Ste B
Vidalia, GA 30474-7201
Phone (912) 535-7100

Other practice location 3

1525 Fair Rd Ste 105A
Statesboro, GA 30458-6118
Phone (800) 207-0008

Other practice location 4

303 Harris Industrial Blvd Ste 5
Vidalia, GA 30474-8854
Phone (912) 535-7000

National Provider Directory

National Provider Directory

Locations

1525 Fair Rd
Ste 105A
Statesboro, GA 30458
Phone (276) 591-8383

1703 Meadows Ln
Vidalia, GA 30474
Phone (912) 537-8921

303 Harris Industrial Blvd
Ste 5
Vidalia, GA 30474
Phone (912) 535-7000

Interoperability endpoints

  • Direct secure messaging: allahna.coggins@srpcc.gadirect.net
  • Direct secure messaging: amber.joyner@srpcc.gadirect.net
  • Direct secure messaging: andrew.burton@srpcc.gadirect.net
  • Direct secure messaging: anju.sinha@srpcc.gadirect.net
  • Direct secure messaging: archie.kirkley@srpcc.gadirect.net
  • Direct secure messaging: ashley.adams@srpcc.gadirect.net
  • Direct secure messaging: bradley.young@srpcc.gadirect.net
  • Direct secure messaging: cara.anderson@srpcc.gadirect.net
  • Direct secure messaging: caryn.mastermansmith@srpcc.gadirect.net
  • Direct secure messaging: chelsea.tehan@srpcc.gadirect.net
  • Direct secure messaging: christina.tidwell@srpcc.gadirect.net
  • Direct secure messaging: christy.brocato@srpcc.gadirect.net
  • Direct secure messaging: ciara.haugabrook@srpcc.gadirect.net
  • Direct secure messaging: courtney.ragan@srpcc.gadirect.net
  • Direct secure messaging: daniel.hartley@srpcc.gadirect.net
  • Direct secure messaging: gilbert.gonzalez@srpcc.gadirect.net
  • Direct secure messaging: henry.ferland@srpcc.gadirect.net
  • Direct secure messaging: herbert.jones@srpcc.gadirect.net
  • Direct secure messaging: jeanie.allen@srpcc.gadirect.net
  • Direct secure messaging: karen.mccoll@srpcc.gadirect.net

Practitioners & affiliated clinicians

Practitioners 37

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.

View all 37

NPI Registry JSON

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

{
    "created_epoch": "1156118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1552435200000",
    "number": "1467568907",
    "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": "912-535-3011",
            "fax_number": "912-538-5529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "ONE MEADOWS PARKWAY",
            "city": "VIDALIA",
            "state": "GA",
            "postal_code": "304748921",
            "telephone_number": "912-535-3011",
            "fax_number": "912-537-5366"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "621 E 1st St Ste B",
            "address_purpose": "LOCATION",
            "city": "Vidalia",
            "state": "GA",
            "postal_code": "304744264",
            "country_code": "US",
            "telephone_number": "912-535-5555",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1707 Meadows Ln Ste B",
            "address_purpose": "LOCATION",
            "city": "Vidalia",
            "state": "GA",
            "postal_code": "304747201",
            "country_code": "US",
            "telephone_number": "912-535-7100",
            "fax_number": "912-535-7120",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1525 Fair Rd Ste 105A",
            "address_purpose": "LOCATION",
            "city": "Statesboro",
            "state": "GA",
            "postal_code": "304586118",
            "country_code": "US",
            "telephone_number": "800-207-0008",
            "fax_number": "912-538-5592",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "303 Harris Industrial Blvd Ste 5",
            "address_purpose": "LOCATION",
            "city": "Vidalia",
            "state": "GA",
            "postal_code": "304748854",
            "country_code": "US",
            "telephone_number": "912-535-7000",
            "fax_number": "912-535-7020",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SOUTHEAST REGIONAL PRIMARY CARE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-21",
        "last_updated": "2019-03-13",
        "status": "A",
        "authorized_official_last_name": "OSTEEN",
        "authorized_official_first_name": "TONY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "912-535-8691"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "GA",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QS1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Sleep Disorder Diagnostic",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vidalia, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2019; 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.