Southeast Spine Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

051119 Issued in GA

Legal business name

SOUTHEAST SPINE CENTER, LLC

Practice address

7450 Skidaway Rd
Savannah, GA 31406-6446

Phone

(912) 233-6811

Fax

(912) 544-0864

NPI assigned

Jun 25, 2013

Organization subpart

No

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

Authorized official

Name

Dr. Ortelio Bosch, M.D.NPI 1629046842

Title

Owner

Phone

(912) 233-6811

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 2

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

• Russell K Daniel, M.D.

  • Pain Medicine (Anesthesiology) Physician
  • Aiken, SC
  • NPI 1376540260

  GA

  Medicare reassignment NPD
• Ortelio Bosch, MD

  • Interventional Pain Medicine Physician
  • Savannah, GA
  • NPI 1629046842
  NPD Authorized official

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

{
    "created_epoch": "1372118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1372118400000",
    "number": "1982044707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7450 SKIDAWAY RD",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314066446",
            "telephone_number": "912-233-6811",
            "fax_number": "912-544-0864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7450 SKIDAWAY RD",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314066446",
            "telephone_number": "912-233-6811",
            "fax_number": "912-544-0864"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST SPINE CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-25",
        "last_updated": "2013-06-25",
        "status": "A",
        "authorized_official_last_name": "BOSCH",
        "authorized_official_first_name": "ORTELIO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "912-233-6811",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "GA",
            "license": "051119",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Southeast Lung & Critical Care Specialists, PC
• Southeast Lung & Critical Care Specialists, PC
• Southeast Lung & Criticial Care Specialists, PC
• Southeast Scripts
• Southeast Spine Care and Pain Management
• Southeastern Audiology, Inc.
• Southeastern Medical Compounding LLC
• Southeastern Medical Equip
• Southeastern OB/GYN Center LLC
• Southeastern Oral and Maxillofacial Surgical Associates P.C.

• All providers in Savannah, GA
• Ambulatory Surgical Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2013; 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.