Provider Demographics
NPI:1023383247
Name:SOUTHEAST LUNG & CRITICAL CARE SPECIALISTS, P.C.
Entity Type:Organization
Organization Name:SOUTHEAST LUNG & CRITICAL CARE SPECIALISTS, P.C.
Other - Org Name:SOUTHEAST LUNG ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-629-0457
Mailing Address - Street 1:PO BOX 14417
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31416-1417
Mailing Address - Country:US
Mailing Address - Phone:912-629-2290
Mailing Address - Fax:912-629-2291
Practice Address - Street 1:11705 MERCY BLVD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-1711
Practice Address - Country:US
Practice Address - Phone:912-629-2290
Practice Address - Fax:912-629-2291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-21
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000526336AMedicaid
GA000914922AMedicaid
GA487007710AMedicaid
GA696088793AMedicaid
GA000148519LMedicaid
GA000272709EMedicaid
GA000788818LMedicaid
GA003112189AMedicaid
GA000473833FMedicaid
GA000272709EMedicaid
202I295903Medicare PIN
11SCHRFMedicare PIN
GA003112189AMedicaid
GA202I294675Medicare PIN
29BDCFNMedicare PIN
GA000526336AMedicaid
GA000788818LMedicaid
GA202I294672Medicare PIN
29BDBZWMedicare PIN