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General NPI Number Information
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NPI Number | 1972911030
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Entity Type | Organization
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Legal Business Name | SOUTHEASTERN AMBULATORY SURGERY CENTER, LLC
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Dates
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Enumeration Date | 07/31/2014
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Last Update Date | 10/09/2014
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Provider Practice Location Address
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Address Line | 4901 DAWN DR SUITE 1100
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City | LUMBERTON
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State | NC
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Zip | 28360-8207
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Country | US
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Telephone | 910-887-2361
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Fax | 910-887-2370
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Provider Business Mailing Address
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Address Line | 4901 DAWN DR SUITE 1100
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City | LUMBERTON
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State | NC
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Zip | 28360-8207
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Country | US
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Telephone | 910-887-2361
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Fax | 910-887-2370
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Authorized Official
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Title or Position | BUSINESS OFFICE MANAGER
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Name | MRS. PAULA REVELS LOCKLEAR
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Credential | MBA
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Telephone | 910-887-2361
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State | NC
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