SOUTHEASTERN SURGERY NPI 1639536089

NPI Information

SOUTHEASTERN SURGERY is a clinic center in Logan, OH. The provider is a facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). SOUTHEASTERN SURGERY NPI is 1639536089. The provider is registered as an organization entity type.

The provider's business location address is:

144 EAST MAIN STREET
LOGAN, OH
ZIP 43138
Phone: (740) 385-1881
Fax: (740) 385-1875

The provider's authorized official is John Duffy Dewalt .
The authorized official title is Surgeon and has the following contact phone number (740) 385-1881.

The CLIA number assigned to this NPI record is 36D1103111 - home health agency with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/15/2016 and was last updated on 1/15/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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