Organization
SOUTHEASTERN REGIONAL MEDICAL CENTER
Active
Other names
SRMC-Wound Care Professional Services
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES THOMAS JOHNSON III (CFO)
(910) 671-5090
Entity
Organization
Contact information
Practice address
103 W 27TH ST, LUMBERTON, NC 28358-3014
(910) 738-3836
(910) 738-3959
Mailing address
2600 N ELM ST, LUMBERTON, NC 28358-3011
(910) 272-3051
(910) 738-3764
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
H0064
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020XY
BCBS
NC
05
—
5950384
—
NC
Enumeration date
08/21/2008
Last updated
09/25/2009
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