Southeast Physician Associates 1, LLC.

Primary specialty

Exclusive Provider OrganizationTaxonomy code 302F00000X

Legal business name

SOUTHEAST PHYSICIAN ASSOCIATES 1, LLC.

Practice address

10621 N Kendall Dr Ste 211
Miami, FL 33176-1530

Phone

(305) 596-4288

Fax

(305) 596-6378

NPI assigned

May 31, 2017

Organization subpart

No

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

Authorized official

Name

Mr. Rene F Gomez

Title

Ceo

Phone

(305) 596-4288

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1496188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1912435264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10621 N KENDALL DR STE 211",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331761530",
            "telephone_number": "305-596-4288",
            "fax_number": "305-596-6378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10621 N KENDALL DR STE 211",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331761530",
            "telephone_number": "305-596-4288",
            "fax_number": "305-596-6378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST PHYSICIAN ASSOCIATES 1, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-31",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "GOMEZ",
        "authorized_official_first_name": "RENE",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "305-596-4288",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Southeastern Community Mental Health Center Inc
• Southeastern Dental Associates VI

• Exclusive Provider Organization in Miami, FL
• Providers in Miami, FL by specialty
• Exclusive Provider Organization in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.