Provider Demographics
NPI:1205063328
Name:SOUTHEAST HOMECARE & RESPIRATORY SERVICES
Entity type:Organization
Organization Name:SOUTHEAST HOMECARE & RESPIRATORY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AREA MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:C
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-736-3664
Mailing Address - Street 1:PO BOX 2120
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-2120
Mailing Address - Country:US
Mailing Address - Phone:706-437-1776
Mailing Address - Fax:706-437-1798
Practice Address - Street 1:501 W 6TH ST
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:GA
Practice Address - Zip Code:30830-1469
Practice Address - Country:US
Practice Address - Phone:706-437-1776
Practice Address - Fax:706-437-1798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-16
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA4494880003Medicare NSC