Provider Demographics
NPI:1881809267
Name:SOUTHEASTERN HAND REHABILITATION INC
Entity type:Organization
Organization Name:SOUTHEASTERN HAND REHABILITATION INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP, AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-297-7000
Mailing Address - Street 1:6100 KENNERLY RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4368
Mailing Address - Country:US
Mailing Address - Phone:904-739-9757
Mailing Address - Fax:904-739-5501
Practice Address - Street 1:6100 KENNERLY RD
Practice Address - Street 2:SUITE 203
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4368
Practice Address - Country:US
Practice Address - Phone:904-739-9757
Practice Address - Fax:904-448-5501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106705Medicare Oscar/Certification
FL1250100001Medicare NSC