Provider Demographics
NPI:1326796426
Name:SOUTHEASTERN SURGICAL, LLC
Entity Type:Organization
Organization Name:SOUTHEASTERN SURGICAL, LLC
Other - Org Name:RIVERFRONT SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:JOLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-693-2175
Mailing Address - Street 1:1247 RIVERFRONT PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37402-2108
Mailing Address - Country:US
Mailing Address - Phone:423-206-9000
Mailing Address - Fax:
Practice Address - Street 1:1247 RIVERFRONT PKWY STE 100
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37402-2108
Practice Address - Country:US
Practice Address - Phone:423-206-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHEASTERN SURGICAL, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-03-17
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty