MEDICARE: SOUTHEASTERN HEALTH PHYSICIAN SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1073906228
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHEASTERN HEALTH PHYSICIAN SERVICES

Provider Business Mailing Address
First Line	:	1249 CHICKEN FOOT RD
Second Line	:
City	:	HOPE MILLS
State	:	NC
Zip	:	28348-7525
Country	:	US
Telephone Number	:	910-423-1278
Fax Number	:	910-272-7141

Provider Business Practice Location Address
First Line	:	1249 CHICKEN FOOT RD
Second Line	:
City	:	HOPE MILLS
State	:	NC
Zip	:	28348-7525
Country	:	US
Telephone Number	:	910-423-1278
Fax Number	:	910-272-7141

Authorized Official
Title or Position	:	DIRECTOR
Name	:	FORDHAM B BRITT
Credential	:
Telephone Number	:	910-671-5026

Provider Enumeration Date	:	03/12/2015
Last Update Date	:	03/12/2015

Similar Medicare Providers

1174512933 — BARBARA DUST KEITH F.N.P.
Practice Location Address:

1249 CHICKEN FOOT RD
HOPE MILLS, NC
28348-7525

Practice Phone: 910-423-1278
Practice Fax: 910-423-2547

1033122668 — DR. MARIA JEANETTE WATSON M.D.
Practice Location Address:

1249 CHICKEN FOOT RD
HOPE MILLS, NC
28348-7525

Practice Phone: 910-423-1278
Practice Fax: 910-423-2547

1013245117 — SOUTHEASTERN REGIONAL MEDICAL CENTER
Practice Location Address:

1277 CHICKEN FOOT RD.
HOPE MILLS, NC
28348-7525

Practice Phone: 910-272-3051
Practice Fax: 910-738-3764

1073801817 — SHAHLA NAZ M.D.
Practice Location Address:

1249 CHICKEN FOOT RD
HOPE MILLS, NC
28348-7525

Practice Phone: 910-423-1278
Practice Fax: 910-423-2547

1831545383 — KELSEY ELIZABETH SIMMONS D.O.
Practice Location Address:

1249 CHICKEN FOOT RD
HOPE MILLS, NC
28348-7525

Practice Phone: 910-423-1278
Practice Fax: 910-423-2547

1093389231 — SOUTHEASTERN REGIONAL PHYSICIAN SERVICES
Practice Location Address:

1249 CHICKEN FOOT RD STE C
HOPE MILLS, NC
28348-7525

Practice Phone: 910-779-1967
Practice Fax: 910-779-1968

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