Provider Demographics
NPI:1669996195
Name:SOUTHEASTERN IMAGING, INC
Entity type:Organization
Organization Name:SOUTHEASTERN IMAGING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TEA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAGANOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-343-3293
Mailing Address - Street 1:100 S BIRCH RD, STE 1001
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 S BIRCH RD APT 1001
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-1542
Practice Address - Country:US
Practice Address - Phone:954-343-3293
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-26
Last Update Date:2017-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty