Healthcare Provider Details

I. General information

NPI: 1528975927
Provider Name (Legal Business Name): SOUTHEASTERN BOCES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7784 SADDLE CLUB DR
LAMAR CO
81052-8501
US

IV. Provider business mailing address

7784 SADDLE CLUB DR
LAMAR CO
81052-8501
US

V. Phone/Fax

Practice location:
  • Phone: 719-336-9046
  • Fax:
Mailing address:
  • Phone: 719-336-9046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: LOGAN SMITH
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 719-336-9046