=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407661838
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTHEASTERN REGIONAL MEDICAL CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/12/2025
-----------------------------------------------------
Last Update Date | 02/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 W 27TH ST
-----------------------------------------------------
City | LUMBERTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28358-3075
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-671-5290
-----------------------------------------------------
Fax | 910-671-5529
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 W 27TH ST
-----------------------------------------------------
City | LUMBERTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28358-3075
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-671-5290
-----------------------------------------------------
Fax | 910-671-5529
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL STAFF OFFICE MANAGER
-----------------------------------------------------
Name | LORNA LOCKLEAR CLOTHIER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 910-671-5000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------