Organization
SOUTHEASTERN REGIONAL MEDICAL CENTER
Active
Other names
Pain Management Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES THOMAS JOHNSON III (CFO)
(910) 671-5090
Entity
Organization
Contact information
Practice address
4308 LUDGATE ST, LUMBERTON, NC 28358-2461
(910) 671-9298
(910) 671-4850
Mailing address
2600 N ELM ST, LUMBERTON, NC 28358-3011
(910) 272-3051
(910) 738-3764
Taxonomy
Speciality
Code
Description
License number
State
261QP3300X
Pain Clinic/Center
Primary
H0064
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
019V9
BCBS
—
05
—
5909183
—
NC
Enumeration date
04/13/2006
Last updated
01/27/2009
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