# SOUTHEASTERN VASCULAR, P.C.

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Southeastern Surgical Associates PC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205866274
- **Authorized official:** LYNN ELLINWOOD (PRACTICE MANAGER)
- **Authorized official phone:** (508) 775-1984

## Contact information

- **Practice address:** 100 CAMP ST, HYANNIS, MA 02601-3007
- **Practice address phone:** (508) 775-1984
- **Practice address fax:** (508) 790-1897
- **Mailing address:** 100 CAMP ST, HYANNIS, MA 02601-3007
- **Mailing address phone:** (508) 775-1984
- **Mailing address fax:** (508) 790-1897

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208600000X | Surgery Physician | — | NULL | — |
| 208600000X | Surgery Physician | — | — | — |
| 2086S0129X | Vascular Surgery Physician | — | NULL | Yes |
| 2086S0129X | Vascular Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/04/2006
- **Last updated:** 08/30/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 9776605 | — | MA |
| 01 | — | SOM16224 | BCBS | MA |