NPIMap

Organization Active NPI

Southeastern Regional Medical Center

Doing business as St Pauls Medical Clinic

  • Rural Health Clinic/Center
  • Saint Pauls, NC
National Provider Identifier
1710979430
Registry record updated Jan 27, 2009
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 MEDICAL CENTER
Doing business as
St Pauls Medical Clinic
Practice address
128 E Broad St
Saint Pauls, NC 28384-1610
Phone
(910) 865-5955
Fax
(910) 865-3055
NPI assigned
Aug 18, 2005
Last updated
Jan 27, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2009

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

Authorized official

Name
Charles Thomas Johnson III
Title
Cfo
Phone
(910) 671-5090

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X H0064 NC Primary

Addresses

Primary practice location

128 E Broad St
Saint Pauls, NC 28384-1610

Mailing address

2600 N Elm St
Lumberton, NC 28358-3011
Phone (910) 737-3147

Other identifiers 3

IdentifierTypeStateIssuer
011MWOtherNCBLUE CROSS BLUE SHIELD
343999AMedicaidNC
343999CMedicaidNC

Other names 1

  • St Pauls Medical Clinic 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

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1124323200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1233014400000",
    "number": "1710979430",
    "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": "910-737-3147",
            "fax_number": "910-738-3764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "128 E BROAD ST",
            "city": "SAINT PAULS",
            "state": "NC",
            "postal_code": "283841610",
            "telephone_number": "910-865-5955",
            "fax_number": "910-865-3055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN REGIONAL MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-18",
        "last_updated": "2009-01-27",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "910-671-5090",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NC",
            "license": "H0064",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "011MW",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "343999A",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "343999C",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St Pauls Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Pauls, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2009; 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.