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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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