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Organization
SOUTHEAST REGIONAL PRIMARY CARE CORPORATION
Active
Organization
SOUTHEAST REGIONAL PRIMARY CARE CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TONY M OSTEEN (CFO)
(912) 535-8691
Entity
Organization
Contact information
Practice address
ONE MEADOWS PARKWAY, VIDALIA, GA 30474-8921
(912) 535-3011
(912) 537-5366
Mailing address
PO BOX 407, VIDALIA, GA 30475-0407
(912) 535-3011
(912) 538-5529
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
GA
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
NULL
261QP2300X
Primary Care Clinic/Center
—
NULL
261QR0200X
Radiology Clinic/Center
—
NULL
261QS1200X
Sleep Disorder Diagnostic Clinic/Center
—
NULL
Other
Enumeration date
08/21/2006
Last updated
03/13/2019
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