Southeast Ambulance, LLC

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

EMS0000010029 Issued in TN

Legal business name

SOUTHEAST AMBULANCE, LLC

Practice address

2511 Riverside Dr
Suite C-3
Chattanooga, TN 37406-3700

Phone

(423) 624-9990

NPI assigned

Dec 7, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jimmy E Henderlight Jr.

Title

Managing Member

Phone

(423) 624-9990

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1165449600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1861551731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5583",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374060583"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2511 RIVERSIDE DR",
            "address_2": "SUITE C-3",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374063700",
            "telephone_number": "423-624-9990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST AMBULANCE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HENDERLIGHT",
        "authorized_official_first_name": "JIMMY",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "423-624-9990",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "TN",
            "license": "EMS0000010029",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3474827",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Adam James Soufleris, MD
• Nickie K Soufleris, M.D.
• Stephen James Soufleris, M.D.
• Sound Living Inc (Sound Living Counseling)
• Sound Living Inc (Sound Living CMHC)
• Southeast Center for Regenerative Wound Care PC
• Southeast Community Service Agency
• Southeast Eye Specialists PLLC
• Southeast Surgical Solutions LLC
• Southeast Tennessee Health Clinic, LLC

• Land Ambulance in Chattanooga, TN
• Providers in Chattanooga, TN by specialty
• Land Ambulance in Tennessee

• 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.