SOUTHEAST REHABILITATION HOSPITAL (SOUTHEAST REHAB LLC) NPI 1942658729

Family Medicine (Adult Medicine) in Lake Village, AR

NPI 1942658729 Organization Family Medicine Adult Medicine CLIA Number 04D1059020 CLIA Certificate of Waiver

About SOUTHEAST REHABILITATION HOSPITAL (SOUTHEAST REHAB LLC)

Southeast Rehabilitation Hospital (southeast Rehab Llc) is a primary care provider established in Lake Village, Arkansas specializing in family medicine (adult medicine) . The NPI number of Southeast Rehabilitation Hospital (southeast Rehab Llc) is 1942658729 and was assigned on June 2016. The practitioner's primary taxonomy code is 207QA0505X. The provider is registered as an organization and their NPI record was last updated 2 years ago. Southeast Rehabilitation Hospital (southeast Rehab Llc) operates as a single speciality business group with one or more individual providers who practice the same area of specialization. The provider's is doing business as Southeast Rehabilitation Hospital. The authorized official of this NPI record is Cathy M Waldrop (Chairman)

A primary care provider (PCP) like Southeast Rehabilitation Hospital sees people with common medical problems. The primary care provider might be a doctor, physician assistant, nurse practitioner or clinic that are usually involved in your long-term care. A PCP might provide preventive care, treat common medical conditions, identify urgent medical problems and refer you to specialists when necessary. Primary care is usually provided in an outpatient facility but if you are admitted to a hospital your PCP may assist in your care. The most common medical conditions seen by primary care providers are: hypertension, upper respiratory tract infections, depression or anxiety, back pain, arthritis, dermatitis, diabetes, urinary tract infections, etc

The CLIA number of Southeast Rehabilitation Hospital is 04D1059020 registered as a "hospital" facility with a CLIA Certificate of Waiver. This CLIA certificate is issued to Southeast Rehabilitation Hospital to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

NPI

1942658729

Provider NameSOUTHEAST REHABILITATION HOSPITAL (SOUTHEAST REHAB LLC)
Provider Location Address903 BORGOGNONI DR LAKE VILLAGE, AR 71653
Provider Mailing Address903 BORGOGNONI DR LAKE VILLAGE, AR 71653
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Other Organization NameSOUTHEAST REHABILITATION HOSPITAL
Other Name TypeDoing Business As (3)
Enumeration Date06-02-2016
Last Update Date06-28-2019


Primary Taxonomy

Taxonomy Code207QA0505X
ClassificationFamily Medicine
TypeAllopathic & Osteopathic Physicians
SpecializationAdult Medicine
Taxonomy DescriptionDefinition to come.

Business Address

SOUTHEAST REHABILITATION HOSPITAL
903 BORGOGNONI DR
LAKE VILLAGE, AR
ZIP 71653
Phone: (870) 265-4333
Fax: (318) 665-0379

Get Directions


Mailing Address

SOUTHEAST REHABILITATION HOSPITAL
903 BORGOGNONI DR
LAKE VILLAGE, AR
ZIP 71653
Phone: (318) 665-9950
Fax: (318) 665-0379



Authorized Official

Authorized Official Name CATHY M WALDROP
Authorized Official TitleCHAIRMAN
Authorized Official Phone(318) 665-9950

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for the NPI number 1942658729 is:

CLIA Number04D1059020
Facility TypeHOSPITAL
Certificate TypeCertificate of Waiver

Group Taxonomy


193400000X MULTIPLE SINGLE SPECIALTY GROUP - This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.

Secondary Taxonomies


The secondary taxonomy codes define the provider type, classification, and specialization. For individual NPIs the license data is associated to each taxonomy code.

No. Taxonomy Code Type Classification Specialization License No. State Primary
1363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalNo

Taxonomy Description: Not Available

2363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthNo

Taxonomy Description: Not Available

Other Providers at the same location


The following 5 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1376863597CHICOT OPERATIONS, LLC
Organization
Skilled Nursing Facility903 BORGOGNONI DR
LAKE VILLAGE, AR 71653
(870) 265-5337
1700959905SOUTHEAST REHAB LLC
Organization
Rehabilitation Hospital903 BORGOGNONI DR
LAKE VILLAGE, AR 71653
(318) 665-9950
1295276970SOUTHEAST REHAB LLC.
Organization
Nurse Practitioner (Gerontology)903 BORGOGNONI DR
LAKE VILLAGE, AR 71653
(318) 665-9950
1700193133CHICOT SNF OPERATIONS LLC
Organization
Skilled Nursing Facility903 BORGOGNONI DR
LAKE VILLAGE, AR 71653
(870) 265-5337
1922677129JSKMF, LLC
Organization
Skilled Nursing Facility903 BORGOGNONI DR
LAKE VILLAGE, AR 71653
(870) 265-5337

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.