Provider Demographics
NPI:1104174655
Name:SOUTHEAST REGIONAL KIDNEY AND HYPERTENSION SPECIALISTS, LL
Entity type:Organization
Organization Name:SOUTHEAST REGIONAL KIDNEY AND HYPERTENSION SPECIALISTS, LL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:M
Authorized Official - Last Name:OSTEEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-538-5314
Mailing Address - Street 1:PO BOX 407
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30475-0407
Mailing Address - Country:US
Mailing Address - Phone:912-537-4986
Mailing Address - Fax:912-535-2558
Practice Address - Street 1:1811 MANNING DR
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-8921
Practice Address - Country:US
Practice Address - Phone:912-535-2554
Practice Address - Fax:912-535-2558
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHEAST REGIONAL PRIMARY CARE CORPORATIO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-15
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty