Southeast Clinic

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

E1635 Issued in AR

Legal business name

SOUTHEAST CLINIC

Doing business as

Jefferson Management Services, Inc.d/b/a Southeast Clinic

Practice address

750 H L Ross Dr
Monticello, AR 71655-5705

Phone

(870) 367-1413

Fax

(870) 367-0012

NPI assigned

Jun 29, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Lisa M Holaday, M.D.NPI 1346285533

Title

Physician

Phone

(870) 367-1413

Specialties & licenses 1

Addresses

Other names 1

• Jefferson Management Services, Inc.d/b/a Southeast Clinic Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lisa M Holaday, M.D.

  • Specialist
  • Texarkana, AR
  • NPI 1346285533
  NPD (past) Authorized official

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

{
    "created_epoch": "1151539200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1730117755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1920",
            "city": "MONTICELLO",
            "state": "AR",
            "postal_code": "716571920",
            "telephone_number": "870-367-1413",
            "fax_number": "870-367-0012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 H L ROSS DR",
            "city": "MONTICELLO",
            "state": "AR",
            "postal_code": "716555705",
            "telephone_number": "870-367-1413",
            "fax_number": "870-367-0012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HOLADAY",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "870-367-1413",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "AR",
            "license": "E1635",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jefferson Management Services, Inc.d/b/a Southeast Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Susan Wolfe Smith, APRN
• Tina Smith
• South Arkansas Rehabilitation, Inc.
• Southeast Arkansas Pharmacies LLC (The Prescription Pad Pharmacy)
• Southeast Arkansas Pharmacies LLC (The Prescription Pad Pharmacy)
• Southeast Education Service Coop
• Southeast Emergency Medical Service, Inc
• Southern Roots Medical Essentials
• Specialty Eyecare of South Arkansas LLC
• Charles M Spellmann, PHD

• Clinic/Center in Monticello, AR
• Providers in Monticello, AR by specialty
• Clinic/Center in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.