Provider Demographics
NPI:1578506325
Name:SOUTHEASTERN ONCOLOGY ASSOCIATES, PC
Entity Type:Organization
Organization Name:SOUTHEASTERN ONCOLOGY ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:A
Authorized Official - Last Name:CAMPODONICO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-897-8294
Mailing Address - Street 1:PO BOX 660928
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35266-0928
Mailing Address - Country:US
Mailing Address - Phone:205-879-8294
Mailing Address - Fax:205-879-8259
Practice Address - Street 1:2018 BROOKWOOD MEDICAL CTR DR
Practice Address - Street 2:CANCER CENTER
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-6898
Practice Address - Country:US
Practice Address - Phone:205-877-2339
Practice Address - Fax:205-877-1821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALG835Medicare ID - Type Unspecified
ALG836Medicare ID - Type Unspecified