NPIMap

Organization Active NPI

Southeast Lung & Critical Care Specialists, PC

Doing business as Southeast Lung Associates

  • Pulmonary Disease Physician
  • Millen, GA
National Provider Identifier
1659638427
Registry record updated Apr 18, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
Legal business name
SOUTHEAST LUNG & CRITICAL CARE SPECIALISTS, PC
Doing business as
Southeast Lung Associates
Practice address
960 College Ave
Millen, GA 30442-1634
Phone
(912) 629-2290
Fax
(912) 629-2291
NPI assigned
Apr 18, 2012
Last updated
Apr 18, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2012

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

Authorized official

Name
April Young
Title
Practice Administrator
Phone
(912) 629-0457

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RP1001X Primary

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 names 1

  • Southeast Lung Associates Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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…

Other NPIs on the same Medicare enrollment 33

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 33

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1334707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1334707200000",
    "number": "1659638427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "340 EISENHOWER DR",
            "address_2": "BLDG #1500",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314061600",
            "telephone_number": "912-354-6614",
            "fax_number": "912-353-7836"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "960 COLLEGE AVE",
            "city": "MILLEN",
            "state": "GA",
            "postal_code": "304421634",
            "telephone_number": "912-629-2290",
            "fax_number": "912-629-2291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST LUNG & CRITICAL CARE SPECIALISTS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-18",
        "last_updated": "2012-04-18",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "APRIL",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "912-629-0457"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southeast Lung Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Millen, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2012; 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.