Organization
VIDALIA ORTHOPEDIC CENTER, LLC
Active
Parent organization
SOUTHEAST REGIONAL PRIMARY CARE CORPORATION
Other names
Southeast Regional Primary Care Corp
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOUTHEAST REGIONAL PRIMARY CARE CORPORATION
Authorized official
TONY M OSTEEN (CFO)
(912) 538-5314
Entity
Organization
Contact information
Practice address
1707 MEADOWS LN, SUITE H, VIDALIA, GA 30474-7200
(912) 538-0040
(912) 538-8133
Mailing address
PO BOX 407, VIDALIA, GA 30475-0407
(912) 538-0040
(912) 538-8133
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
333690169B
—
GA
05
—
333690169C
—
GA
05
—
489633273A
—
GA
Enumeration date
01/22/2009
Last updated
06/12/2014
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