Provider Demographics
NPI:1093122384
Name:SOUTHEAST MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:SOUTHEAST MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:UKACHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-385-8664
Mailing Address - Street 1:3320 SKYWAY DR STE 807
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-7141
Mailing Address - Country:US
Mailing Address - Phone:334-539-1770
Mailing Address - Fax:334-539-1775
Practice Address - Street 1:3320 SKYWAY DR STE 807
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-7141
Practice Address - Country:US
Practice Address - Phone:334-539-1770
Practice Address - Fax:334-539-1775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-18
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care