Provider Demographics
NPI:1730501735
Name:SOUTHEAST LUNG & CRITICAL CARE SPECIALISTS, PC
Entity Type:Organization
Organization Name:SOUTHEAST LUNG & CRITICAL CARE SPECIALISTS, PC
Other - Org Name:SOUTHEAST LUNG ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-629-0457
Mailing Address - Street 1:PO BOX 14417
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31416-1417
Mailing Address - Country:US
Mailing Address - Phone:912-629-2290
Mailing Address - Fax:912-629-2291
Practice Address - Street 1:1921 WHITTLESEY RD
Practice Address - Street 2:SUITE # 530
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-3099
Practice Address - Country:US
Practice Address - Phone:912-629-2290
Practice Address - Fax:912-629-2291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-09
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003129391AMedicaid
GA795377228AMedicaid
GA000526336AMedicaid
GA003124134CMedicaid
GA003129392AMedicaid
GA003134446AMedicaid
GA003137375AMedicaid
GA221012519BMedicaid
GA003126241AMedicaid
GA003134446AMedicaid
GA202I502513Medicare PIN
GA202I504201Medicare PIN
GA003124134CMedicaid
GA795377228AMedicaid
GA50BBFCPMedicare PIN
GA003129392AMedicaid
GA003126241AMedicaid
GA29BDBXPMedicare PIN