NPIMap

Organization Active NPI

Southeast Rehab LLC

  • Adult Medicine Physician
  • Lake Village, AR
National Provider Identifier
1942658729
Registry record updated Jun 28, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Medicine PhysicianTaxonomy code 207QA0505X
Legal business name
SOUTHEAST REHAB LLC
Practice address
903 Borgognoni Dr
Lake Village, AR 71653-1623
Phone
(870) 265-4333
Fax
(318) 665-0379
NPI assigned
Jun 2, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2019

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

Authorized official

Name
Cathy M Waldrop
Title
Chairman
Phone
(318) 665-9950

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207QA0505X Primary
Medical Physician AssistantGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363AM0700X
Adult Health Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363LA2200X

Addresses

Primary practice location

903 Borgognoni Dr
Lake Village, AR 71653-1623

Mailing address

903 Borgognoni Dr
Lake Village, AR 71653-1623
Phone (318) 665-9950

Other names 1

  • Southeast Rehabilitation Hospital Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Southeast Rehab LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

NPI Registry JSON

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

{
    "created_epoch": "1464825600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1561680000000",
    "number": "1942658729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "903 BORGOGNONI DR",
            "city": "LAKE VILLAGE",
            "state": "AR",
            "postal_code": "716531623",
            "telephone_number": "318-665-9950",
            "fax_number": "318-665-0379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "903 BORGOGNONI DR",
            "city": "LAKE VILLAGE",
            "state": "AR",
            "postal_code": "716531623",
            "telephone_number": "870-265-4333",
            "fax_number": "318-665-0379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST REHAB LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-02",
        "last_updated": "2019-06-28",
        "status": "A",
        "authorized_official_last_name": "WALDROP",
        "authorized_official_first_name": "CATHY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CHAIRMAN",
        "authorized_official_telephone_number": "318-665-9950"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine, Adult Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southeast Rehabilitation Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake Village, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2019; 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.