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Organization
SOUTHEASTERN REGIONAL MEDICAL CENTER
Active
Organization
SOUTHEASTERN REGIONAL MEDICAL CENTER
Active
Other names
Southeastern Urgent Care Pembroke
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES T. JOHNSON (CFO)
(910) 671-5909
Entity
Organization
Contact information
Practice address
812 CANDY PARK RD, PEMBROKE, NC 28372-9129
(910) 272-3051
(910) 738-3764
Mailing address
2600 N ELM ST, LUMBERTON, NC 28358-3011
(910) 272-3051
(910) 738-3764
Taxonomy
Speciality
Code
Description
License number
State
261QU0200X
Urgent Care Clinic/Center
Primary
H0064
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
019V4
BCBS
NC
05
—
5909123
—
NC
Enumeration date
01/10/2008
Last updated
04/21/2009
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