NPIMap

Organization Active NPI

Southeastern Regional Physician Services

  • Rural Health Clinic/Center
  • Maxton, NC
National Provider Identifier
1356767669
Registry record updated Sep 26, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
H0064 Issued in NC
Legal business name
SOUTHEASTERN REGIONAL PHYSICIAN SERVICES
Practice address
22401 Andrew Jackson Hwy
Maxton, NC 28364-6721
Phone
(910) 844-2004
Fax
(910) 844-3798
NPI assigned
Mar 11, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2016

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X H0064 NC
Primary Care Clinic/Center 261QP2300X H0064 NC
Rural Health Clinic/Center 261QR1300X H0064 NC Primary

Addresses

Primary practice location

22401 Andrew Jackson Hwy
Maxton, NC 28364-6721

Mailing address

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

Other names 1

  • Southeastern Medical Clinic Maxton 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 3

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": "1394496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474848000000",
    "number": "1356767669",
    "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": "22401 ANDREW JACKSON HWY",
            "city": "MAXTON",
            "state": "NC",
            "postal_code": "283646721",
            "telephone_number": "910-844-2004",
            "fax_number": "910-844-3798"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN REGIONAL PHYSICIAN SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-11",
        "last_updated": "2016-09-26",
        "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": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "H0064",
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NC",
            "license": "H0064",
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NC",
            "license": "H0064",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southeastern Medical Clinic Maxton",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Maxton, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2016; 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.