| Southeastern Psychiatric Providers, Llc | |
|
2050 Mercantile Dr Apt C9 Leland NC 28451-4053 | |
| (910) 370-2500 | |
| Not Available |
| Full Name | Southeastern Psychiatric Providers, Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 2050 Mercantile Dr Apt C9, Leland, North Carolina |
| Authorized Official Name and Position | Benjamin Donaldson (OWNER/AUTHORIZED) |
| Authorized Official Contact | 4083646160 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southeastern Psychiatric Providers, Llc Po Box 3516 Wilmington NC 28406-0516 Ph: (408) 364-6160 | Southeastern Psychiatric Providers, Llc 2050 Mercantile Dr Apt C9 Leland NC 28451-4053 Ph: (910) 370-2500 |
| NPI Number | 1811492853 |
|---|---|
| Provider Enumeration Date | 03/29/2018 |
| Last Update Date | 03/29/2018 |
| Medicare PECOS PAC ID | 9436409752 |
|---|---|
| Medicare Enrollment ID | O20180907001822 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811492853 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
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