Provider Demographics
NPI:1588679153
Name:SOUTHEAST CARDIOLOGY ASSOCIATES, P.C.
Entity type:Organization
Organization Name:SOUTHEAST CARDIOLOGY ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHERI
Authorized Official - Middle Name:A
Authorized Official - Last Name:BANKERT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:508-828-1542
Mailing Address - Street 1:72 WASHINGTON ST
Mailing Address - Street 2:SUITE 1400
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-2491
Mailing Address - Country:US
Mailing Address - Phone:508-880-0077
Mailing Address - Fax:508-880-5247
Practice Address - Street 1:72 WASHINGTON ST
Practice Address - Street 2:SUITE 1400
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-2491
Practice Address - Country:US
Practice Address - Phone:508-880-0077
Practice Address - Fax:508-880-5247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0013346OtherNEIGHBORHOOD HEALTH
MACL4606OtherRAILROAD MEDICARE
MDSOM14400OtherBCBS MA GROUP NUMBER
MA717471OtherTUFTS GROUP NO
MA9753974Medicaid
MA717471OtherTUFTS GROUP NO