Provider Demographics
NPI:1538124201
Name:SOUTHEAST ANESTHESIOLOGY CONSULTANTS, PLLC
Entity Type:Organization
Organization Name:SOUTHEAST ANESTHESIOLOGY CONSULTANTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:C
Authorized Official - Last Name:GARRABRANT
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:754-247-4124
Mailing Address - Street 1:1305 WALT WHITMAN RD STE 300
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-4300
Mailing Address - Country:US
Mailing Address - Phone:516-208-4250
Mailing Address - Fax:704-248-5537
Practice Address - Street 1:927 EAST BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203
Practice Address - Country:US
Practice Address - Phone:704-377-5772
Practice Address - Fax:704-377-3389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC406873Medicaid
NC02697OtherBCBSNC
SCDO4297OtherRAILROAD-MEDICARE
NCCC9626OtherRAILROAD-MEDICARE
NC5917101Medicaid
SC9110Medicare PIN
NC230377Medicare PIN