SOUTHEASTERN VASCULAR, P.C. – NPI #1205866274
Surgery

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. is a surgeon located in HYANNIS, MA. NPPES has assigned the NPI number 1205866274 to SOUTHEASTERN VASCULAR, P.C. on July 04, 2006. It is a Type-2 NPI, indicating this NPI number is associated with an organization. The former legal business name for this organization is SOUTHEASTERN SURGICAL ASSOCIATES PC. According to the NPI Registry, there are 2 additional location(s) assigned to this provider which are listed below. With multiple taxonomy codes selected, the primary taxonomy selected by this provider is 2086S0129X from the Health Care Provider Taxonomy code set, which is classified as Surgery, specializing in Vascular Surgery

The NPI profile was previously updated about 5 years ago on Aug 30, 2021. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for SOUTHEASTERN VASCULAR, P.C. below.

NPI Profile for
SOUTHEASTERN VASCULAR, P.C.

NPI Number
1205866274
Enumeration Date

(about 20 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
SOUTHEASTERN VASCULAR, P.C.
Former Legal Business Name: SOUTHEASTERN SURGICAL ASSOCIATES PC
Primary location
100 CAMP ST
HYANNIS, MA 02601-3007
Phone: (508) 775-1984 Fax: (508) 790-1897
2 Other location(s):
800 Falmouth Rd Ste 102A
Mashpee, MA 02649-3363
Phone: (508) 775-1984
20 Indian Hill Road
West Tisbury, MA 02568
Phone: (508) 775-1984
Mailing address
Same as primary location
Organization Subpart
No
Authorized Official
LYNN ELLINWOOD
PRACTICE MANAGER
Phone: (508) 775-1984
Updated
Certification Date
Aug 30, 2021

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Identifiers

Identifiers for SOUTHEASTERN VASCULAR, P.C.

Identifiers are used to associate other provider identifiers such as Medicaid or other insurers (ie:, Blue Cross, Blue Shield, Aetna, Kaiser-Permanente, etc.), with their NPI number. These identifiers can be used in matching an NPI number to an insurer's records. However, not all providers have such numbers and not all providers choose to include them in their NPI information.

DescriptionIssuerStateIdentifier
OTHERBCBSMASOM16224
MEDICAIDMA9776605
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
2086S0129X
- Surgery / Vascular Surgery (Primary)
208600000X
- Surgery

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.