Provider Demographics
NPI:1376358481
Name:SOUTHEAST ALABAMA SURGICAL LLC
Entity type:Organization
Organization Name:SOUTHEAST ALABAMA SURGICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:VOSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-804-3536
Mailing Address - Street 1:1114 GA HIGHWAY 96 STE C1
Mailing Address - Street 2:
Mailing Address - City:KATHLEEN
Mailing Address - State:GA
Mailing Address - Zip Code:31047-4102
Mailing Address - Country:US
Mailing Address - Phone:478-330-5747
Mailing Address - Fax:478-310-3105
Practice Address - Street 1:107 OBRANNAN PARK DRIVE
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303
Practice Address - Country:US
Practice Address - Phone:478-330-5747
Practice Address - Fax:478-310-3105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-07
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center