Southeast Lung & Critical Care Specialists, PC
Organization Active NPI Pulmonary Disease Physician · Waycross, GA
NPI 1861832040 · NPPES record last updated Apr 30, 2014
Key facts
- NPI
- 1861832040
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pulmonary Disease Physician 207RP1001X
- Legal business name
- SOUTHEAST LUNG & CRITICAL CARE SPECIALISTS, PC
- Practice address
- 1900 Tebeau St
Mayo Health Clinic
Waycross, GA 31501-6357 - Phone
- (912) 629-2290
- Fax
- (912) 629-2291
- NPI assigned
- Jul 2, 2013
- 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
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pulmonary Disease Physician |
207RP1001X | Yes |
Addresses
Primary practice location
1900 Tebeau St
Mayo Health Clinic
Waycross, GA 31501-6357
Mailing address
PO Box 14417
Savannah, GA 31416-1417
Phone (912) 629-2290
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000473833F | Medicaid | GA |
Other names
- Southeast Lung Associates
Other providers in Waycross, GA
- Southeast Georgia Health Services, L.L.C.
- Southeast Georgia Mobile Therapy
- Southeast Georgia Pediatrics
- Southeast Georgia Primary Care
- Southeast Internal Medicine PC
- Southeast Lung and Critical Care Specialist
- Southeastern Chiropractic
- Southern Anesthesia Company, LLC.
- Southern Georgia Regional Commission
- Southern Nurse Anesthesiology, LLC
All providers in Waycross, 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 30, 2014. 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.