Provider Demographics
NPI:1255813119
Name:SOUTHEAST PHYSICIAN NETWORK, P.C.
Entity type:Organization
Organization Name:SOUTHEAST PHYSICIAN NETWORK, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-366-9740
Mailing Address - Street 1:509 ENERGY CENTER BLVD STE 804
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35473-2798
Mailing Address - Country:US
Mailing Address - Phone:205-366-9740
Mailing Address - Fax:205-344-9992
Practice Address - Street 1:1410 MCFARLAND BLVD N
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-2209
Practice Address - Country:US
Practice Address - Phone:205-345-8208
Practice Address - Fax:205-345-8209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-06
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiologyGroup - Multi-Specialty