Provider Demographics
NPI:1801035100
Name:40 SOUTHEAST SURGICAL GROUP
Entity Type:Organization
Organization Name:40 SOUTHEAST SURGICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:HEMP
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:561-368-7118
Mailing Address - Street 1:40 SE 5TH ST
Mailing Address - Street 2:SUITE 406
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-6003
Mailing Address - Country:US
Mailing Address - Phone:561-368-7118
Mailing Address - Fax:561-368-7116
Practice Address - Street 1:40 SE 5TH ST
Practice Address - Street 2:SUITE 406
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-6003
Practice Address - Country:US
Practice Address - Phone:561-368-7118
Practice Address - Fax:561-368-7116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-10
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular MedicineGroup - Multi-Specialty