MEDICARE: SOUTHEAST FAMILY HEALTHCARE PC

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	207Q00000X	Family Medicine Physician	22263	AL

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	:	1518066984
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHEAST FAMILY HEALTHCARE PC

Provider Business Mailing Address
First Line	:	15079 S US HIGHWAY 231
Second Line	:
City	:	MIDLAND CITY
State	:	AL
Zip	:	36350-6305
Country	:	US
Telephone Number	:	334-983-5994
Fax Number	:	334-983-4954

Provider Business Practice Location Address
First Line	:	15079 S US HIGHWAY 231
Second Line	:
City	:	MIDLAND CITY
State	:	AL
Zip	:	36350-6305
Country	:	US
Telephone Number	:	334-983-5994
Fax Number	:	334-983-4954

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	TERESA C LASSITER
Credential	:
Telephone Number	:	334-983-5994

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	04/30/2013

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