Provider Demographics
NPI:1316708480
Name:SOUTHEASTERN MEDICAL ASSOCIATES, LLC
Entity type:Organization
Organization Name:SOUTHEASTERN MEDICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAVED
Authorized Official - Middle Name:FIROZ
Authorized Official - Last Name:PATKA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:839-400-4440
Mailing Address - Street 1:1750 HIGHWAY 160 W STE 101-239
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8009
Mailing Address - Country:US
Mailing Address - Phone:839-400-4440
Mailing Address - Fax:
Practice Address - Street 1:1795 DR FRANK GASTON BLVD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1190
Practice Address - Country:US
Practice Address - Phone:839-400-4440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty