NPIMap

Organization Active NPI

Southeastern Regional Physician Services

  • Multi-Specialty Clinic/Center
  • Lumberton, NC
National Provider Identifier
1003244286
Registry record updated Jan 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
License
H0064 Issued in NC
Legal business name
SOUTHEASTERN REGIONAL PHYSICIAN SERVICES
Practice address
725 Oakridge Blvd Ste A3
Lumberton, NC 28358-2351
Phone
(910) 738-1141
Fax
(910) 738-6011
NPI assigned
Oct 24, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Fordham B. Britt
Title
Director
Phone
(910) 671-5026

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X H0064 NC Primary

Addresses

Primary practice location

725 Oakridge Blvd Ste A3
Lumberton, NC 28358-2351

Mailing address

2002 N Cedar St Ste B
Lumberton, NC 28358-3926
Phone (910) 272-3048

Other practice location 1

4384 Fayetteville Rd
Lumberton, NC 28358-2677
Phone (910) 738-1141

Other names 1

  • Southeastern Medical Specialists Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100106000556 NC Part B Supplier - Clinic/Group Practice 7012058548 Receives reassigned benefits from 140 practitioners
31 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Pembroke, NC; Lumberton, NC; Hope Mills, NC

Other NPIs on the same Medicare enrollment 31

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 31

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1382572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611532800000",
    "number": "1003244286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2002 N CEDAR ST STE B",
            "city": "LUMBERTON",
            "state": "NC",
            "postal_code": "283583926",
            "telephone_number": "910-272-3048",
            "fax_number": "910-738-3764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 OAKRIDGE BLVD STE A3",
            "city": "LUMBERTON",
            "state": "NC",
            "postal_code": "283582351",
            "telephone_number": "910-738-1141",
            "fax_number": "910-738-6011"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4384 Fayetteville Rd",
            "address_purpose": "LOCATION",
            "city": "Lumberton",
            "state": "NC",
            "postal_code": "283582677",
            "country_code": "US",
            "telephone_number": "910-738-1141",
            "fax_number": "910-738-6011",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SOUTHEASTERN REGIONAL PHYSICIAN SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-24",
        "last_updated": "2021-01-25",
        "certification_date": "2021-01-25",
        "status": "A",
        "authorized_official_last_name": "BRITT",
        "authorized_official_first_name": "FORDHAM",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "910-671-5026"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NC",
            "license": "H0064",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southeastern Medical Specialists",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Southeastern Medical Specialists",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lumberton, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.