Southeast Lung & Critical Care Specialists, PC
Organization Active NPI Pulmonary Disease Physician · Millen, GA
NPI 1659638427 · NPPES record last updated Apr 18, 2012
Key facts
- NPI
- 1659638427
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pulmonary Disease Physician 207RP1001X
- Legal business name
- SOUTHEAST LUNG & CRITICAL CARE SPECIALISTS, PC
- Practice address
- 960 College Ave
Millen, GA 30442-1634 - Phone
- (912) 629-2290
- Fax
- (912) 629-2291
- NPI assigned
- Apr 18, 2012
- Organization subpart
- No
Authorized official
- Name
- April Young
- Title
- Practice Administrator
- Phone
- (912) 629-0457
Other NPIs on the same Medicare enrollment 33
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040415000176 | GA | Part B Supplier - Clinic/Group Practice | 7618962291 |
Receives reassigned benefits from 29 practitioners 33 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Jesup, GA; Vidalia, GA; Tybee Island, GA; Sylvania, GA; Springfield, GA; Savannah, GA; Hinesville, GA; Brunswick, GA… |
National Provider Directory
Locations
340 Eisenhower Dr
Ste 1500
Savannah, GA 31406
Phone (912) 443-4253
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pulmonary Disease Physician |
207RP1001X | Yes |
Addresses
Primary practice location
960 College Ave
Millen, GA 30442-1634
Mailing address
340 Eisenhower Dr
BLDG #1500
Savannah, GA 31406-1600
Phone (912) 354-6614
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000526336T | Medicaid | GA | |
| 003105926A | Medicaid | GA |
Other names
- Southeast Lung Associates
Other providers in Millen, GA
- Sedzer Health LLC
- Sedzer Health LLC
- Sedzer Health LLC
- Heather Campbell Smoak
- Southeast Lung & Critical Care Specialists
- Southland Optim Jenkins Emergency Medical Services, LLC
- Walgreen Co
- Erin Ward
- Alexandra Byers Weathersby
- Yurhealth, LLC
All providers in Millen, GA · Pulmonary Disease Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 18, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.