Southeastern Endoscopy Center LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

SOUTHEASTERN ENDOSCOPY CENTER LLC

Practice address

2200 Hamilton Rd Ste a
Columbus, GA 31904-8889

Phone

(706) 655-8800

NPI assigned

Dec 5, 2022

Organization subpart

No

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

Authorized official

Name

Shane DarrahNPI 1679557375

Title

Ceo

Phone

(706) 326-6743

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 5

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

• Shane B Darrah, M.D.

  • Interventional Cardiology Physician
  • Columbus, GA
  • NPI 1679557375
  Medicare reassignment NPD Authorized official
• Mark Routon Fortson, M.D.

  • Gastroenterology Physician
  • Columbus, GA
  • NPI 1457452591
  Medicare reassignment NPD
• Daniel L Schoenborn, DO

  • Gastroenterology Physician
  • Columbus, GA
  • NPI 1326252503
  Medicare reassignment NPD
• Carter Douglas Wallace, MD

  • Pediatric Gastroenterology Physician
  • Columbus, GA
  • NPI 1497037899
  Medicare reassignment NPD
• Humberto Jose Rios, MD

  • Gastroenterology Physician
  • Columbus, GA
  • NPI 1316439987
  NPD (past)

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

{
    "created_epoch": "1670198400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1671408000000",
    "number": "1932819554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8629",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319088629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 HAMILTON RD STE A",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319048889",
            "telephone_number": "706-655-8800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN ENDOSCOPY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-05",
        "last_updated": "2022-12-19",
        "certification_date": "2022-12-19",
        "status": "A",
        "authorized_official_last_name": "DARRAH",
        "authorized_official_first_name": "SHANE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "706-326-6743"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Southeast Lung & Critical Care Specialists, PC
• Southeast Regional Pain Ctr PC
• Southeastern Anesthesia Group LLC
• Southeastern Cardiology Associates PC
• Southeastern Dental Center-Columbus LLC
• Southeastern Gastroenterology Associates, PC
• Southeastern Home Oxygen Services
• Southeastern Support Care Services LLC
• Southern Charm Counseling Services
• Southern Diabetes Management

• Ambulatory Surgical Clinic/Center in Columbus, GA
• Providers in Columbus, GA by specialty
• Ambulatory Surgical Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.