Healthcare Provider Details

I. General information

NPI: 1962926451
Provider Name (Legal Business Name): SOUTHEASTERN REGIOINAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2017
Last Update Date: 11/03/2022
Certification Date: 11/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W 27TH ST
LUMBERTON NC
28358-3075
US

IV. Provider business mailing address

300 W 27TH ST
LUMBERTON NC
28358-3075
US

V. Phone/Fax

Practice location:
  • Phone: 910-670-5000
  • Fax: 910-670-8512
Mailing address:
  • Phone: 910-670-5000
  • Fax: 910-670-8512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: CHARLES T. JOHNSON III
Title or Position: VP/CFO
Credential:
Phone: 910-671-5090