Provider Demographics
NPI:1598703498
Name:SOUTHEASTERN SURGICAL ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:SOUTHEASTERN SURGICAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURENCE
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:ENDERSON
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:757-422-2212
Mailing Address - Street 1:840 FIRST COLONIAL RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-6106
Mailing Address - Country:US
Mailing Address - Phone:757-422-2212
Mailing Address - Fax:757-422-9177
Practice Address - Street 1:840 FIRST COLONIAL RD
Practice Address - Street 2:SUITE 102
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-6106
Practice Address - Country:US
Practice Address - Phone:757-422-2212
Practice Address - Fax:757-422-9177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC01923Medicare ID - Type Unspecified