Provider Demographics
NPI:1477635480
Name:SOUTHEASTERN OHIO PHYSICIANS, INC.
Entity Type:Organization
Organization Name:SOUTHEASTERN OHIO PHYSICIANS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:C
Authorized Official - Last Name:NEFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-432-5685
Mailing Address - Street 1:100 CLARK CT
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-9395
Mailing Address - Country:US
Mailing Address - Phone:740-432-5685
Mailing Address - Fax:740-432-3812
Practice Address - Street 1:100 CLARK CT
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-9395
Practice Address - Country:US
Practice Address - Phone:740-432-5685
Practice Address - Fax:740-432-3812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0440017Medicaid
OHSO9922761Medicare ID - Type Unspecified