Provider Demographics
NPI:1205546454
Name:SOUTHEASTERN REGENERATIVE INSTITUTE
Entity type:Organization
Organization Name:SOUTHEASTERN REGENERATIVE INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:DURRETT
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:803-642-6500
Mailing Address - Street 1:15 MOSS CREEK VLG
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-1105
Mailing Address - Country:US
Mailing Address - Phone:803-642-6500
Mailing Address - Fax:803-642-6472
Practice Address - Street 1:15 MOSS CREEK VLG
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-1105
Practice Address - Country:US
Practice Address - Phone:803-642-6500
Practice Address - Fax:803-642-6472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty