Southeastern Regional Physician Services
Organization Active NPI Rural Health Clinic/Center · Fairmont, NC
NPI 1659508653 · NPPES record last updated Jun 17, 2009
Key facts
- NPI
- 1659508653
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- License
- H0064 (NC)
- Legal business name
- SOUTHEASTERN REGIONAL PHYSICIAN SERVICES
- Practice address
- 101 N Walnut St
Fairmont, NC 28340-1951 - Phone
- (910) 628-0655
- Fax
- (910) 738-3764
- NPI assigned
- Jun 17, 2009
- Organization subpart
- No
Authorized official
- Name
- Charles T. Johnson
- Title
- Cfo
- Phone
- (910) 671-5090
Corporate family (same tax ID) 37
National Provider Directory
- Tax ID family
- Southeastern ASC
Locations
725 Oakridge Blvd
Ste C1
Lumberton, NC 28358
Phone (910) 738-9414
4901 Dawn Dr
Ste 3300
Lumberton, NC 28360
Phone (910) 671-5410
4307 Fayetteville Rd
Lumberton, NC 28358
Phone (910) 671-9000
22401 Andrew Jackson Hwy
Maxton, NC 28364
Phone (910) 390-9431
923 W 3rd St
Pembroke, NC 28372
Phone (910) 521-0564
812 Candy Park Rd
Ste 5103
Pembroke, NC 28372
Phone (910) 671-6619
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | H0064 | NC | Yes |
Addresses
Primary practice location
101 N Walnut St
Fairmont, NC 28340-1951
Mailing address
2600 N Elm St
Lumberton, NC 28358-3011
Phone (910) 272-3051
Other names
- Fairmont Medical Clinic
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All providers in Fairmont, NC · Rural Health Clinic/Center in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 17, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.