NPIMap

Organization Active NPI

Southeastern Regional Medical Center

Doing business as Southeastern Urgent Care Pembroke

  • Urgent Care Clinic/Center
  • Pembroke, NC
National Provider Identifier
1588840490
Registry record updated Apr 21, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
License
H0064 Issued in NC
Legal business name
SOUTHEASTERN REGIONAL MEDICAL CENTER
Doing business as
Southeastern Urgent Care Pembroke
Practice address
812 Candy Park Rd
Pembroke, NC 28372-9129
Phone
(910) 272-3051
Fax
(910) 738-3764
NPI assigned
Jan 10, 2008
Last updated
Apr 21, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2009

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

Authorized official

Name
Mr. Charles T. Johnson
Title
Cfo
Phone
(910) 671-5909

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urgent Care Clinic/Center 261QU0200X H0064 NC Primary

Addresses

Primary practice location

812 Candy Park Rd
Pembroke, NC 28372-9129

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
019V4OtherNCBCBS
5909123MedicaidNC

Other names 1

  • Southeastern Urgent Care Pembroke 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

NPI Registry JSON

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

{
    "created_epoch": "1199923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1240272000000",
    "number": "1588840490",
    "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": "812 CANDY PARK RD",
            "city": "PEMBROKE",
            "state": "NC",
            "postal_code": "283729129",
            "telephone_number": "910-272-3051",
            "fax_number": "910-738-3764"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN REGIONAL MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-10",
        "last_updated": "2009-04-21",
        "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": "910-671-5909",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "NC",
            "license": "H0064",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "019V4",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5909123",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southeastern Urgent Care Pembroke",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pembroke, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 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.