MEDICARE: SOUTHEASTERN HEALTH PLUS, INC.

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
1	332BC3200X	Customized Equipment (DME)		SC

Other Identifiers

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

General Provider Information

NPI Number	:	1124026547
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHEASTERN HEALTH PLUS, INC.

Provider Business Mailing Address
First Line	:	1301 48TH AVE N STE C
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-5427
Country	:	US
Telephone Number	:	843-839-1374
Fax Number	:	877-408-8192

Provider Business Practice Location Address
First Line	:	1301 48TH AVE N STE C
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-5427
Country	:	US
Telephone Number	:	843-839-1374
Fax Number	:	877-408-8192

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFI
Name	:	MR. JOHN J MORAN
Credential	:
Telephone Number	:	843-939-1374

Provider Enumeration Date	:	07/09/2005
Last Update Date	:	06/09/2014

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