NPIMap

Organization Active NPI

Southeastern Regional Physician Services

Doing business as Southeastern Spine & Pain Clinic

  • Neurological Surgery Physician
  • Lumberton, NC
National Provider Identifier
1407281082
Registry record updated Oct 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
H0064 Issued in NC
Legal business name
SOUTHEASTERN REGIONAL PHYSICIAN SERVICES
Doing business as
Southeastern Spine & Pain Clinic
Practice address
4901 Dawn Dr Ste 3300
Lumberton, NC 28360-8288
Phone
(910) 671-9298
Fax
(910) 671-4850
NPI assigned
Sep 13, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2020

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

Authorized official

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207T00000X H0064 NC Primary
Pain Clinic/Center 261QP3300X H0064 NC

Addresses

Primary practice location

4901 Dawn Dr Ste 3300
Lumberton, NC 28360-8288

Mailing address

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

Other names 1

  • Southeastern Spine & Pain Clinic 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

Locations

106 Farm Brook Dr
Ste C
Lumberton, NC 28358
Phone (919) 727-9373

Practitioners & affiliated clinicians

Practitioners 1

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": "1379030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602115200000",
    "number": "1407281082",
    "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": "4901 DAWN DR STE 3300",
            "city": "LUMBERTON",
            "state": "NC",
            "postal_code": "283608288",
            "telephone_number": "910-671-9298",
            "fax_number": "910-671-4850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN REGIONAL PHYSICIAN SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-13",
        "last_updated": "2020-10-08",
        "certification_date": "2020-10-08",
        "status": "A",
        "authorized_official_last_name": "BRITT",
        "authorized_official_first_name": "FORDHAM",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "910-671-5026"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Neurological Surgery",
            "state": "NC",
            "license": "H0064",
            "primary": true
        },
        {
            "code": "261QP3300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Pain",
            "state": "NC",
            "license": "H0064",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southeastern Spine & Pain Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Southeastern Spine & Pain Clinic",
            "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 Oct 8, 2020; 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.