SOUTHEASTERN VASCULAR P.C. NPI 1205866274

NPI Information

  • NPI: 1205866274
  • Provider Name: SOUTHEASTERN VASCULAR, P.C.
  • Classification: Surgery - 2086S0129X
  • Specialization: Vascular Surgery
  • Entity Type: Organization
  • Former Legal Business Name: SOUTHEASTERN SURGICAL ASSOCIATES PC
  • Address: 100 CAMP ST
    HYANNIS, MA
    ZIP 02601
  • Phone: (508) 775-1984

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NPI Details

SOUTHEASTERN VASCULAR, P.C. is a vascular surgery surgery in Hyannis, MA. The provider is a surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. SOUTHEASTERN VASCULAR, P.C. NPI is 1205866274. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Former Legal Business Name Is Southeastern Surgical Associates Pc.

The provider's business location address is:

100 CAMP ST
HYANNIS, MA
ZIP 02601-007
Phone: (508) 775-1984
Fax: (508) 790-1897

The provider's authorized official is Lynn Ellinwood .
The authorized official title is Practice Manager and has the following contact phone number (508) 775-1984.

The enumeration date for this NPI number is 7/4/2006 and was last updated on 8/30/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208600000XSurgeryNo
22086S0129XSurgeryVascular SurgeryYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
19776605MEDICAIDMASSACHUSETTS
2SOM16224OTHERMASSACHUSETTSBCBS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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