Provider Demographics
NPI:1326187444
Name:SOUTHERN OCEAN PRIMARY CARE ASSOCIATES LLC
Entity Type:Organization
Organization Name:SOUTHERN OCEAN PRIMARY CARE ASSOCIATES LLC
Other - Org Name:SOUTHERN OCEAN PRIMARY CARE ASSC LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BETTINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-978-6266
Mailing Address - Street 1:53 NAUTILUS DRIVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050
Mailing Address - Country:US
Mailing Address - Phone:609-978-6266
Mailing Address - Fax:609-978-5006
Practice Address - Street 1:53 NAUTILUS DRIVE
Practice Address - Street 2:SUITE B
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050
Practice Address - Country:US
Practice Address - Phone:609-978-6266
Practice Address - Fax:609-978-5006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
144238Medicare PIN