| NPI | 1780376533 |
|---|---|
| Doing Business As | SOUTHEAST PHYSICIAN SERVICES |
| Other Name | 1115 MH WAIVER |
| Entity Type | Organization |
| Authorized Contact | JOSEPH WANNER Chief Financial Officer 907-796-8402 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2023-05-22 |
| Last Update Date | 2023-11-21 |