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Organization
SOUTHEASTERN VASCULAR, P.C.
Active
Organization
SOUTHEASTERN VASCULAR, P.C.
Active
Other names
Southeastern Surgical Associates PC
Organization subpart
No
Provider details
NPI number
Authorized official
LYNN ELLINWOOD (PRACTICE MANAGER)
(508) 775-1984
Entity
Organization
Contact information
Practice address
100 CAMP ST, HYANNIS, MA 02601-3007
(508) 775-1984
(508) 790-1897
Mailing address
100 CAMP ST, HYANNIS, MA 02601-3007
(508) 775-1984
(508) 790-1897
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
—
NULL
208600000X
Surgery Physician
—
—
2086S0129X
Vascular Surgery Physician
Primary
—
NULL
2086S0129X
Vascular Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9776605
—
MA
01
—
SOM16224
BCBS
MA
Enumeration date
07/04/2006
Last updated
08/30/2021
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