Provider Demographics
NPI:1871901009
Name:SOUTHEASTERN RECONSTRUCTIVE SERVICES LLC
Entity type:Organization
Organization Name:SOUTHEASTERN RECONSTRUCTIVE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:WECHSLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-354-4969
Mailing Address - Street 1:PO BOX 15878
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31416-2578
Mailing Address - Country:US
Mailing Address - Phone:912-354-4969
Mailing Address - Fax:912-354-5019
Practice Address - Street 1:5205 FREDERICK ST STE B
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4520
Practice Address - Country:US
Practice Address - Phone:912-354-4969
Practice Address - Fax:912-354-5019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA226512086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty