Provider Demographics
NPI:1932402195
Name:SOUTHEAST ANESTHESIOLOGY CONSULTANTS, PLLC
Entity Type:Organization
Organization Name:SOUTHEAST ANESTHESIOLOGY CONSULTANTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:C
Authorized Official - Last Name:GARRABRANT
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:754-247-4124
Mailing Address - Street 1:1305 WALT WHITMAN RD STE 300
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-4300
Mailing Address - Country:US
Mailing Address - Phone:516-208-4250
Mailing Address - Fax:704-248-5537
Practice Address - Street 1:2520 INDEPENDENCE BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412
Practice Address - Country:US
Practice Address - Phone:910-442-1100
Practice Address - Fax:910-442-1199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-09
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5917193Medicaid
NC024AJOtherBCBS
NCCK0203OtherRAILROAD-MEDICARE
SCQPB699Medicaid
NC230377AMedicare PIN