Provider Demographics
NPI:1487221180
Name:SOUTHEAST VASCULAR GROUP LP
Entity Type:Organization
Organization Name:SOUTHEAST VASCULAR GROUP LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAYNE
Authorized Official - Middle Name:R
Authorized Official - Last Name:YONEHIRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-429-0102
Mailing Address - Street 1:PO BOX 30090
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-1090
Mailing Address - Country:US
Mailing Address - Phone:850-429-0102
Mailing Address - Fax:850-429-0803
Practice Address - Street 1:1619 CREIGHTON RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-7152
Practice Address - Country:US
Practice Address - Phone:850-429-0100
Practice Address - Fax:850-429-0803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty