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
—
—
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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