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General NPI Number Information
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NPI Number | 1811900178
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Entity Type | Organization
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Legal Business Name | SOUTHEASTERN MEDICAL CENTER, P.C.
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Dates
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Enumeration Date | 08/15/2006
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Last Update Date | 07/06/2010
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Provider Practice Location Address
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Address Line | 700 TILGHMAN DR SUITE720
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City | DUNN
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State | NC
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Zip | 28334-0007
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Country | US
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Telephone | 910-892-4941
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Fax |
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Provider Business Mailing Address
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Address Line | 700 TILGHMAN DR SUITE720
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City | DUNN
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State | NC
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Zip | 28334-0007
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Country | US
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Telephone | 910-892-4941
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. MISTI SUZANNE PHILLIPS
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Credential | RMM
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Telephone | 910-892-4941
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 9401258
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License Number State | NC
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