Provider Demographics
NPI:1013416155
Name:SOUTHEASTERN BRACING LLC
Entity Type:Organization
Organization Name:SOUTHEASTERN BRACING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:MCBRAYER
Authorized Official - Suffix:
Authorized Official - Credentials:ORTHOTIC FITTER
Authorized Official - Phone:205-807-2251
Mailing Address - Street 1:120 AUSTIN CIR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-7069
Mailing Address - Country:US
Mailing Address - Phone:205-807-2251
Mailing Address - Fax:
Practice Address - Street 1:200 CAHABA PARK CIR STE 212
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-8115
Practice Address - Country:US
Practice Address - Phone:205-807-2251
Practice Address - Fax:205-582-9641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-05
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies