Healthcare Provider Details

I. General information

NPI: 1366346389
Provider Name (Legal Business Name): SOUTHEASTERN INTEGRATED FAMILY MEDICINE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 LIVERMORE DR
PEMBROKE NC
28372-7322
US

IV. Provider business mailing address

PO BOX 1572
LUMBERTON NC
28359-1572
US

V. Phone/Fax

Practice location:
  • Phone: 910-522-0408
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: JHONATHAN MATTHEW STRICKLAND
Title or Position: VP PROGRAM OPERATIONS
Credential:
Phone: 910-522-0408