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NPI Code Detail

MEDICARE: SOUTHEASTERN REGIONAL MEDICAL CENTER

MEDICARE: SOUTHEASTERN REGIONAL MEDICAL CENTER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QR1300XRural Health Clinic/CenterH0064NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10260KOTHERNCBLUE CROSS BLUE SHIELD
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1194720466
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTHEASTERN REGIONAL MEDICAL CENTER
Provider Business Mailing Address
First Line : 2600 N ELM ST
Second Line :
City : LUMBERTON
State : NC
Zip : 28358-3011
Country : US
Telephone Number : 910-272-3051
Fax Number : 910-738-3764
Provider Business Practice Location Address
First Line : 101 N WALNUT ST
Second Line :
City : FAIRMONT
State : NC
Zip : 28340-1951
Country : US
Telephone Number : 910-628-0655
Fax Number : 910-628-0158
Authorized Official
Title or Position : VICE PRESIDENT FINANCE
Name : CHARLES THOMAS JOHNSON III
Credential :
Telephone Number : 910-671-5090
Provider Enumeration Date : 06/14/2005
Last Update Date : 01/27/2009

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Practice Location Address:
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1790784619 — DIANA M. MCKEITHAN FNP-C
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1811965692 — MRS. AUNDREA RAE EMANUEL FNP
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Practice Fax: 910-628-0158
1659508653 — SOUTHEASTERN REGIONAL PHYSICIAN SERVICES
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1235565755 — WALGREEN CO
Practice Location Address:
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1679081319 — EULALIA CIDELA BARAJAS-GRAHAM PA
Practice Location Address:
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Practice Fax: 910-628-0158

Directions to “SOUTHEASTERN REGIONAL MEDICAL CENTER ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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