Southeastern Surgery

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

34. 002686 Issued in OH

Legal business name

SOUTHEASTERN SURGERY

Practice address

144 East Main Street
Logan, OH 43138

Phone

(740) 385-1881

Fax

(740) 385-1875

NPI assigned

Jan 15, 2016

Organization subpart

No

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

Authorized official

Name

Dr. John Duffy Dewalt, DO

Title

Surgeon

Phone

(740) 385-1881

Specialties & licenses 1

Addresses

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/12746/brand/1/csg/1/fhir/r4

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

{
    "created_epoch": "1452816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1452816000000",
    "number": "1639536089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12413 STATE ROUTE 93 N",
            "city": "LOGAN",
            "state": "OH",
            "postal_code": "431389306",
            "telephone_number": "740-385-3318",
            "fax_number": "740-385-1875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "144 EAST MAIN STREET",
            "city": "LOGAN",
            "state": "OH",
            "postal_code": "43138",
            "telephone_number": "740-385-1881",
            "fax_number": "740-385-1875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-15",
        "last_updated": "2016-01-15",
        "status": "A",
        "authorized_official_last_name": "DEWALT",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "DUFFY",
        "authorized_official_title_or_position": "SURGEON",
        "authorized_official_telephone_number": "740-385-1881",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "OH",
            "license": "34. 002686",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Phyllis Jean Smith
• Darren J Sommer, D.O
• Katherine Soucie
• South Central Ohio Anesthesia LLC
• Southeastern Ohio Home Health & Staffing Solutions Inc
• Lindsay D Spackey, QMHS
• Speech on the Spot SE Ohio
• Amy Speidel
• Brian Speidel
• Cheryl Spence

• Clinic/Center in Logan, OH
• Providers in Logan, OH by specialty
• Clinic/Center in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2016; 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.