Healthcare Provider Details

I. General information

NPI: 1568761963
Provider Name (Legal Business Name): SOUTHEASTERN REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2011
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
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
28358-3098
US

V. Phone/Fax

Practice location:
  • Phone: 910-735-8806
  • Fax: 910-735-8803
Mailing address:
  • Phone: 910-735-8806
  • Fax: 910-735-8803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number10389
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFREY LEE EDGE
Title or Position: PHARMACY SUPERVISOR
Credential: PHARM. D.
Phone: 910-735-8806