Provider Demographics
NPI:1265146609
Name:SOUTHEAST INSTITUTE FOR OPTIMAL HEALTH
Entity type:Organization
Organization Name:SOUTHEAST INSTITUTE FOR OPTIMAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:VARNADORE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:850-231-3165
Mailing Address - Street 1:PO BOX 611057
Mailing Address - Street 2:
Mailing Address - City:ROSEMARY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32461-1000
Mailing Address - Country:US
Mailing Address - Phone:850-231-3165
Mailing Address - Fax:
Practice Address - Street 1:82 S BARRETT SQ STE 2F
Practice Address - Street 2:
Practice Address - City:ROSEMARY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32461-6930
Practice Address - Country:US
Practice Address - Phone:850-231-3165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty