NPIMap

Organization Active NPI

Southeast Regional Primary Care Corporation

Doing business as Meadows Medical Group Pediatrics

  • Pediatrics Physician
  • Vidalia, GA
National Provider Identifier
1790288413
Registry record updated Mar 9, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
SOUTHEAST REGIONAL PRIMARY CARE CORPORATION
Doing business as
Meadows Medical Group Pediatrics
Practice address
125 Church St
Vidalia, GA 30474-4770
Phone
(912) 538-8484
NPI assigned
Mar 9, 2018
Last updated
Mar 9, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2018

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

Authorized official

Name
Tony M O'Steen
Title
Cfo
Phone
(912) 535-5560

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X NU Primary

Addresses

Primary practice location

125 Church St
Vidalia, GA 30474-4770

Mailing address

PO Box 407
Vidalia, GA 30475-0407
Phone (912) 538-8484

Other names 1

  • Meadows Medical Group Pediatrics Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Southeast Regional Primary Care Corporation12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

Locations

125 Church St
Vidalia, GA 30474
Phone (912) 538-8484

NPI Registry JSON

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

{
    "created_epoch": "1520553600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1520553600000",
    "number": "1790288413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 407",
            "city": "VIDALIA",
            "state": "GA",
            "postal_code": "304750407",
            "telephone_number": "912-538-8484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 CHURCH ST",
            "city": "VIDALIA",
            "state": "GA",
            "postal_code": "304744770",
            "telephone_number": "912-538-8484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST REGIONAL PRIMARY CARE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-09",
        "last_updated": "2018-03-09",
        "status": "A",
        "authorized_official_last_name": "O'STEEN",
        "authorized_official_first_name": "TONY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "912-535-5560"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Meadows Medical Group Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Vidalia, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2018; 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.