NPIMap

Organization Active NPI

Southeastern Regional Physician Services

  • Otolaryngology Physician
  • Lumberton, NC
National Provider Identifier
1699014191
Registry record updated Feb 5, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
H0064 Issued in NC
Legal business name
SOUTHEASTERN REGIONAL PHYSICIAN SERVICES
Practice address
4303 Ludgate St
Lumberton, NC 28358-2460
Phone
(910) 738-4226
Fax
(910) 738-8844
NPI assigned
Feb 5, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2013

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

Authorized official

Name
Mr. Michael Ernest Brown
Title
Director
Phone
(910) 671-5044

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Y00000X H0064 NC Primary

Addresses

Primary practice location

4303 Ludgate St
Lumberton, NC 28358-2460

Mailing address

2600 N Elm St
Lumberton, NC 28358-3011
Phone (910) 671-5290

Other names 1

  • Southeastern Ear Nose and Throat Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Southeastern ASC38 organizations share this tax ID, including this one

Other organizations with this tax ID 37

Organizations that report the same tax identification number in the National Provider Directory.

View all 37

NPI Registry JSON

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

{
    "created_epoch": "1360022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1360022400000",
    "number": "1699014191",
    "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": "910-671-5290",
            "fax_number": "910-738-3764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4303 LUDGATE ST",
            "city": "LUMBERTON",
            "state": "NC",
            "postal_code": "283582460",
            "telephone_number": "910-738-4226",
            "fax_number": "910-738-8844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN REGIONAL PHYSICIAN SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-05",
        "last_updated": "2013-02-05",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "ERNEST",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "910-671-5044",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Otolaryngology",
            "state": "NC",
            "license": "H0064",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southeastern Ear Nose and Throat",
            "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 Feb 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.