Organization
SOUTHEASTERN REGIONAL MEDICAL CENTER
Active
Other names
Southeastern Recovery Alternatives
Organization subpart
No
Provider details
NPI number
Authorized official
MR. C. THOMAS JOHNSON III CFO (V. P. FINANCE)
(910) 671-5090
Entity
Organization
Contact information
Practice address
4303 LUDGATE ST, LUMBERTON, NC 28358-2460
(910) 671-5000
(910) 671-5858
Mailing address
300 W 27TH ST, LUMBERTON, NC 28358-3075
(910) 671-5000
(910) 671-5858
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
H0064
NC
1041C0700X
Clinical Social Worker
H0064
NC
207L00000X
Anesthesiology Physician
H0064
NC
2084P0800X
Psychiatry Physician
HOO64
NC
261Q00000X
Clinic/Center
Primary
H0064
NC
363A00000X
Physician Assistant
H0064
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8300343Q
—
NC
Enumeration date
05/02/2006
Last updated
02/24/2016
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