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Organization

SOUTHEASTERN REGIONAL MEDICAL CENTER

Active
Other names
Southeastern Digestive Health Center
Organization subpart
No

Provider details

NPI number
Authorized official
CHARLES T. JOHNSON III (CFO)
(910) 671-5090
Entity
Organization

Contact information

Practice address
730 OAKRIDGE BLVD STE A, LUMBERTON, NC 28358-2324
(910) 272-3051
(910) 738-3764
Mailing address
2600 N ELM ST, LUMBERTON, NC 28358-3011
(910) 272-3051

Taxonomy

Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
H0064
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
019V5
BCBS
NC
05
5907836
NC
Enumeration date
11/13/2007
Last updated
01/27/2009
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