Organization
VIDALIA PULMONOLOGY CENTER, LLC
Active
Parent organization
SOUTHEAST REGIONAL PRIMARY CARE CORPORATION
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOUTHEAST REGIONAL PRIMARY CARE CORPORATION
Authorized official
TONY M O'STEEN (CFO)
(912) 538-5314
Entity
Organization
Contact information
Practice address
1811 EDWINA DR, VIDALIA, GA 30474-8963
(912) 538-8105
(912) 538-8109
Mailing address
PO BOX 407, VIDALIA, GA 30475-0407
(912) 538-8105
(912) 538-8109
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
—
—
207RP1001X
Pulmonary Disease Physician
Primary
—
—
207RS0012X
Sleep Medicine (Internal Medicine) Physician
—
—
Other
Enumeration date
06/13/2008
Last updated
05/29/2014
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