MEDICARE: SOUTHEAST MEDICAL ASSOCIATES LLC

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1871798348
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHEAST MEDICAL ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	1301 48TH AVE N STE B
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-5427
Country	:	US
Telephone Number	:	843-215-5102
Fax Number	:	843-215-5226

Provider Business Practice Location Address
First Line	:	1301 48TH AVE N STE B
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-5427
Country	:	US
Telephone Number	:	843-215-5102
Fax Number	:	843-215-5226

Authorized Official
Title or Position	:	INS CLERK
Name	:	MS. CINDY L HANEY
Credential	:
Telephone Number	:	843-215-5102

Provider Enumeration Date	:	06/15/2007
Last Update Date	:	08/22/2020

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