Provider Demographics
NPI:1114996352
Name:SOUTHEASTERN PLASTIC SURGERY PC
Entity Type:Organization
Organization Name:SOUTHEASTERN PLASTIC SURGERY PC
Other - Org Name:SOUTHEASTERN HAND CENTER & OCCUPATIONAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OTRL
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYS
Authorized Official - Suffix:
Authorized Official - Credentials:OTRL
Authorized Official - Phone:704-864-7574
Mailing Address - Street 1:649 N NEW HOPE RD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054
Mailing Address - Country:US
Mailing Address - Phone:704-866-4005
Mailing Address - Fax:704-866-0450
Practice Address - Street 1:760 N NEW HOPE RD
Practice Address - Street 2:STE A
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054
Practice Address - Country:US
Practice Address - Phone:704-864-7574
Practice Address - Fax:704-866-8680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2510725Medicare ID - Type UnspecifiedGROUP