NPIMap

Organization Active NPI

Southeastern Regional Medical Center

  • Clinic/Center
  • Clarkton, NC
National Provider Identifier
1033396155
Registry record updated Jan 27, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
H0064 Issued in NC
Legal business name
SOUTHEASTERN REGIONAL MEDICAL CENTER
Practice address
9928 N. W.R. Lathan Street
Clarkton, NC 28433
Phone
(910) 272-3051
Fax
(910) 738-3764
NPI assigned
Jan 31, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2009

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

Authorized official

Name
Mr. Charles T. Johnson III
Title
Cfo
Phone
(910) 671-5090

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X H0064 NC Primary

Addresses

Primary practice location

9928 N. W.R. Lathan Street
Clarkton, NC 28433

Mailing address

2600 N Elm St
Lumberton, NC 28358-3011
Phone (910) 272-3051

Other identifiers 2

IdentifierTypeStateIssuer
020EHOtherNCBCBS
5908813MedicaidNC

Other names 1

  • Southeastern Health Center Clarkton Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040119000154 NC Part B Supplier - Clinic/Group Practice 7315857141 Receives reassigned benefits from 71 practitioners
41 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lumberton, NC

Other NPIs on the same Medicare enrollment 41

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

View all 41

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

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": "1201737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1233014400000",
    "number": "1033396155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 N ELM ST",
            "city": "LUMBERTON",
            "state": "NC",
            "postal_code": "283583011",
            "telephone_number": "910-272-3051",
            "fax_number": "910-738-3764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9928 N. W.R. LATHAN STREET",
            "city": "CLARKTON",
            "state": "NC",
            "postal_code": "28433",
            "telephone_number": "910-272-3051",
            "fax_number": "910-738-3764"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN REGIONAL MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-31",
        "last_updated": "2009-01-27",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "910-671-5090",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NC",
            "license": "H0064",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "020EH",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5908813",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southeastern Health Center Clarkton",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clarkton, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2009; 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.