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NPI Code Detail

MEDICARE: HOSPITAL PHYSICIAN SERVICES - SOUTHEAST PROFESSIONAL CORPORATION

MEDICARE: HOSPITAL PHYSICIAN SERVICES - SOUTHEAST PROFESSIONAL CORPORATION
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant
2363L00000XNurse Practitioner
3208M00000XHospitalist Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2DE6935OTHERGAMEDICARE TRAVELERS RR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1760410385
Entity Type Code : Organization
Provider Name (Legal Business Name) : HOSPITAL PHYSICIAN SERVICES - SOUTHEAST PROFESSIONAL CORPORATION
Provider Business Mailing Address
First Line : 1643 NW 136TH AVE STE 100
Second Line :
City : SUNRISE
State : FL
Zip : 33323-2857
Country : US
Telephone Number : 800-424-3672
Fax Number : 954-377-3042
Provider Business Practice Location Address
First Line : 2151 W SPRING ST
Second Line :
City : MONROE
State : GA
Zip : 30655-3202
Country : US
Telephone Number : 770-267-8461
Fax Number :
Authorized Official
Title or Position : PE DIRECTOR
Name : TONYA LYNN SCANLAN
Credential :
Telephone Number : 954-377-2954
Provider Enumeration Date : 06/30/2006
Last Update Date : 01/14/2025

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Directions to “HOSPITAL PHYSICIAN SERVICES - SOUTHEAST PROFESSIONAL CORPORATION ” Practice Location

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