{
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"OrgName": "SOUTHEASTERN REGIONAL PHYSICIAN SERVICES",
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"FirstLineMailingAddress": "2002 N CEDAR ST STE B",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LUMBERTON",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "28358-3926",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "910-272-3048",
"MailingAddressFaxNumber": "910-738-3764",
"FirstLinePracticeLocationAddress": "4901 DAWN DR STE 3300",
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"PracticeLocationAddressCityName": "LUMBERTON",
"PracticeLocationAddressStateName": "NC",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "910-671-9298",
"PracticeLocationAddressFaxNumber": "910-671-4850",
"EnumerationDate": "09/13/2013",
"LastUpdateDate": "10/08/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BRITT",
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"AuthorizedOfficialTitle": "DIRECTOR",
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"AuthorizedOfficialTelephoneNumber": "910-671-5026",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "261QP3300X",
"TaxonomyName": "Pain Clinic/Center",
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"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "207T00000X",
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"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}