Southeastern Integrated Care

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

SOUTHEASTERN INTEGRATED CARE

Practice address

68 Three Hunts Dr Ste a
Pembroke, NC 28372-7319

Phone

(910) 522-0408

Fax

(704) 931-9199

NPI assigned

Jun 23, 2016

Organization subpart

No

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

Authorized official

Name

Mr. Daniel Z. Morman

Title

Ceo

Phone

(704) 294-1075

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

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

• Southeastern Integrated Care

  dba Lumber River Family Practice

  • Family Medicine Physician
  • Lumberton, NC
  • NPI 1326036138

  O20170214000330

  Same enrollment

Locations

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

{
    "created_epoch": "1466640000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487289600000",
    "number": "1245681048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "68 THREE HUNTS DR STE A",
            "city": "PEMBROKE",
            "state": "NC",
            "postal_code": "283727319",
            "telephone_number": "910-522-0408",
            "fax_number": "704-931-9199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "68 THREE HUNTS DR STE A",
            "city": "PEMBROKE",
            "state": "NC",
            "postal_code": "283727319",
            "telephone_number": "910-522-0408",
            "fax_number": "704-931-9199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN INTEGRATED CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-23",
        "last_updated": "2017-02-17",
        "status": "A",
        "authorized_official_last_name": "MORMAN",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "Z.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "704-294-1075",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Denene P. Smith, FNP
• Donnesha Smith
• James Donta Smith
• Lavirsa Smith
• Megan Elizabeth Smith
• Southeastern Regional Medical Center (Southeastern Urgent Care Pembroke)
• Southeastern Regional Physician Services (Southeastern Urgent Care Pembroke)
• Southeastern United Care LLC
• Southeastern United Care, LLC
• Southeastern United Care,LLC

• Primary Care Clinic/Center in Pembroke, NC
• Providers in Pembroke, NC by specialty
• Primary Care Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2017; 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.