Provider Demographics
NPI:1568589802
Name:SOUTHEASTERN MEDICAL CENTER S.C.
Entity Type:Organization
Organization Name:SOUTHEASTERN MEDICAL CENTER S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NETWORK ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RAJEEV
Authorized Official - Middle Name:
Authorized Official - Last Name:BHAREL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-933-4889
Mailing Address - Street 1:PO BOX 704
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46325-0704
Mailing Address - Country:US
Mailing Address - Phone:219-933-4889
Mailing Address - Fax:219-933-3153
Practice Address - Street 1:4020 S CALUMET AVE
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46320-1129
Practice Address - Country:US
Practice Address - Phone:219-933-4889
Practice Address - Fax:219-933-3153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01031453A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100214150AMedicaid
IL0090001298OtherBCBS IL
IN000000105624OtherBLUE CROSS OF IN
IN100214150AMedicaid
IN0509200001Medicare NSC
IN100214150AMedicaid