Healthcare Provider Details

I. General information

NPI: 1487093027
Provider Name (Legal Business Name): SOUTHEAST HEALTHCARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2013
Last Update Date: 06/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 DAN RIVER DR
SPRING HILL FL
34606-5422
US

IV. Provider business mailing address

230 DAN RIVER DR
SPRING HILL FL
34606-5422
US

V. Phone/Fax

Practice location:
  • Phone: 352-346-3246
  • Fax:
Mailing address:
  • Phone: 352-346-3246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AGNES AUGELLO
Title or Position: MANAGER
Credential:
Phone: 352-346-3246