Provider Demographics
NPI:1447315726
Name:SOUTHEASTERN FERTILITY CENTER PA
Entity type:Organization
Organization Name:SOUTHEASTERN FERTILITY CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:H
Authorized Official - Last Name:RODGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-881-3900
Mailing Address - Street 1:1375 HOSPITAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3254
Mailing Address - Country:US
Mailing Address - Phone:843-881-3900
Mailing Address - Fax:843-881-4729
Practice Address - Street 1:1375 HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3254
Practice Address - Country:US
Practice Address - Phone:843-881-3900
Practice Address - Fax:843-881-4729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22525207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty