Organization
SOUTHEASTERN REGIONAL MEDICAL CENTER
Active
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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