Basic Information
| Provider Information | |||||||||
| NPI: | 1861702425 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTHEAST ANESTHESIOLOGY CONSULTANTS, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1500 CONCORD TER | ||||||||
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| City: | SUNRISE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333232815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002433839 | ||||||||
| FaxNumber: | 8446862961 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 GREEN VALLEY ROAD | ||||||||
| Address2: | SUITE 304 | ||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362824840 | ||||||||
| FaxNumber: | 3362824660 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2010 | ||||||||
| LastUpdateDate: | 07/13/2018 | ||||||||
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| AuthorizedOfficialLastName: | MILLER | ||||||||
| AuthorizedOfficialFirstName: | JOSHUA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9543840175 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 023XH | 01 | NC | BCBS | OTHER | 5916559 | 05 | NC | MEDICAID | CK0203 | 01 | NC | RAILROAD-MEDICARE | OTHER |