Provider Demographics
NPI:1689036477
Name:SOUTHEASTERN DIAGNOSTICS, LLC
Entity type:Organization
Organization Name:SOUTHEASTERN DIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:WAINSCOTT
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:205-613-5255
Mailing Address - Street 1:109 FOOTHILLS PKWY
Mailing Address - Street 2:SUITE 113
Mailing Address - City:CHELSEA
Mailing Address - State:AL
Mailing Address - Zip Code:35043-8235
Mailing Address - Country:US
Mailing Address - Phone:205-619-5255
Mailing Address - Fax:205-618-9706
Practice Address - Street 1:86261 HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:AL
Practice Address - Zip Code:36251-7823
Practice Address - Country:US
Practice Address - Phone:205-613-5255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonographyGroup - Multi-Specialty