NPIMap

Organization Active NPI

Southeast Physician Network, P.C.

  • Hematology & Oncology Physician
  • Tuscaloosa, AL
National Provider Identifier
1598090839
Registry record updated Sep 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
10900 Issued in AL
Legal business name
SOUTHEAST PHYSICIAN NETWORK, P.C.
Practice address
1410 McFarland Blvd N
Tuscaloosa, AL 35406-2209
Phone
(205) 345-8208
Fax
(205) 345-8209
NPI assigned
Oct 5, 2009
Last updated
Sep 10, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2019

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

Authorized official

Name
Dr. Shelby Sanford, MDNPI 1689681967
Title
President
Phone
(205) 345-8208

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RH0003X 10900 AL Primary
Radiation Oncology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0001X 10900 AL
Urology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208800000X 10900 AL

Addresses

Primary practice location

1410 McFarland Blvd N
Tuscaloosa, AL 35406-2209

Mailing address

1400 Afflink PL Ste 101
Tuscaloosa, AL 35406-2452
Phone (205) 345-8208

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091026000423 AL Part B Supplier - Clinic/Group Practice 0840337721 Receives reassigned benefits from 58 practitioners
Practice locations: Demopolis, AL; Winfield, AL; Tuscaloosa, AL; Selma, AL; Northport, AL; Jasper, AL

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

509 Energy Center Blvd
Ste 804
Northport, AL 35473
Phone 2053669740 ext. 1425

1023 Medical Center Pkwy
Ste 110
Selma, AL 36701
Phone (334) 375-4777

1780 McFarland Blvd N
Tuscaloosa, AL 35406
Phone (205) 345-7351

Practitioners & affiliated clinicians

Practitioners 62

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 62

NPI Registry JSON

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

{
    "created_epoch": "1254700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1568073600000",
    "number": "1598090839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 AFFLINK PL STE 101",
            "city": "TUSCALOOSA",
            "state": "AL",
            "postal_code": "354062452",
            "telephone_number": "205-345-8208",
            "fax_number": "205-345-8209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1410 MCFARLAND BLVD N",
            "city": "TUSCALOOSA",
            "state": "AL",
            "postal_code": "354062209",
            "telephone_number": "205-345-8208",
            "fax_number": "205-345-8209"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST PHYSICIAN NETWORK, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-05",
        "last_updated": "2019-09-10",
        "status": "A",
        "authorized_official_last_name": "SANFORD",
        "authorized_official_first_name": "SHELBY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "205-345-8208",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "AL",
            "license": "10900",
            "primary": true
        },
        {
            "code": "2085R0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Radiation Oncology",
            "state": "AL",
            "license": "10900",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Urology",
            "state": "AL",
            "license": "10900",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tuscaloosa, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.