Healthcare Provider Details

I. General information

NPI: 1740564376
Provider Name (Legal Business Name): SOUTHEASTERN REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2011
Last Update Date: 08/26/2022
Certification Date: 08/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 W 27TH ST
LUMBERTON NC
28358-3014
US

IV. Provider business mailing address

300 W 27TH ST
LUMBERTON NC
28358-3075
US

V. Phone/Fax

Practice location:
  • Phone: 910-738-3836
  • Fax:
Mailing address:
  • Phone: 910-671-5590
  • Fax: 910-670-8512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SARA BETH BRADLEY
Title or Position: VP/CFO
Credential: CFO
Phone: 910-671-5297