Organization
SOUTHEASTERN REGIONAL MEDICAL CENTER
Active
Other names
Southeastern Health Center Clarkton
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES T. JOHNSON III (CFO)
(910) 671-5090
Entity
Organization
Contact information
Practice address
9928 N. W.R. LATHAN STREET, CLARKTON, NC 28433
(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
261Q00000X
Clinic/Center
Primary
H0064
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020EH
BCBS
NC
05
—
5908813
—
NC
Enumeration date
01/31/2008
Last updated
01/27/2009
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