| Organization Name: | SOUTHEAST MEDICAL CENTER PC |
| NPI Number: | 1124034509 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | THERESA KELLY (ADMINISTRATOR) |
| Mailing Address: | 102 10th Avenue West Lisbon |
| State: | ND US |
| Postal Code: | 580541097 |
| Phone Number: | 7016832214 |
| Fax Number: | 7016832130 |
| NPI Enumeration Date: | 07/31/2006 |
| NPI Last Update Date: | 06/09/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QC1500X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Community Health |
| Taxonomy Definition: | |