Provider Demographics
NPI:1619277688
Name:SOUTHEASTERN MEDICAL SERVICES LLC
Entity Type:Organization
Organization Name:SOUTHEASTERN MEDICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RIDDEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-292-5500
Mailing Address - Street 1:PO BOX 722606
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-8981
Mailing Address - Country:US
Mailing Address - Phone:405-292-5500
Mailing Address - Fax:405-292-5505
Practice Address - Street 1:1225 W MAIN ST
Practice Address - Street 2:STE 205
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6824
Practice Address - Country:US
Practice Address - Phone:405-292-5500
Practice Address - Fax:405-292-5505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK16862207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty