Healthcare Provider Details

I. General information

NPI: 1831807825
Provider Name (Legal Business Name): SOUTHEASTERN TRANSITIONAL CARE MANAGEMENT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2022
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 LAKELAND EAST DR STE 210
FLOWOOD MS
39232-9777
US

IV. Provider business mailing address

660 LAKELAND EAST DR STE 210
FLOWOOD MS
39232-9777
US

V. Phone/Fax

Practice location:
  • Phone: 601-664-4162
  • Fax:
Mailing address:
  • Phone: 601-665-4162
  • Fax: 888-799-9237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN DUKE
Title or Position: COO
Credential:
Phone: 601-665-4162