Organization
SOUTHEAST REGIONAL CARDIAC AND VASCULAR INSTITUTE, 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 OSTEEN (CFO)
(912) 537-5314
Entity
Organization
Contact information
Practice address
101 HARRIS INDUSTRIAL BLVD, SUITE A, VIDALIA, GA 30474-8852
(912) 535-3500
(912) 535-4498
Mailing address
PO BOX 407, VIDALIA, GA 30475-0407
(912) 535-3500
(912) 535-4498
Taxonomy
Speciality
Code
Description
License number
State
207RI0011X
Interventional Cardiology Physician
Primary
65260
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
489617065A
—
GA
Enumeration date
03/09/2010
Last updated
11/04/2020
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