Southeastern Regional Medical Center
Organization Active NPI Health Maintenance Organization · Lumberton, NC
NPI 1780831776 · NPPES record last updated Sep 25, 2009
Key facts
- NPI
- 1780831776
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Health Maintenance Organization 302R00000X
- License
- H0064 (NC)
- Legal business name
- SOUTHEASTERN REGIONAL MEDICAL CENTER
- Practice address
- 103 W 27TH St
Lumberton, NC 28358-3014 - Phone
- (910) 738-3836
- Fax
- (910) 738-3959
- NPI assigned
- Aug 21, 2008
- Organization subpart
- No
Authorized official
- Name
- Mr. Charles Thomas Johnson III
- Title
- Cfo
- Phone
- (910) 671-5090
Other NPIs on the same Medicare enrollment 41
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Health Maintenance Organization | 302R00000X | H0064 | NC | Yes |
Addresses
Primary practice location
103 W 27TH St
Lumberton, NC 28358-3014
Mailing address
2600 N Elm St
Lumberton, NC 28358-3011
Phone (910) 272-3051
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 020XY | Other | NC | BCBS |
| 5950384 | Medicaid | NC |
Other names
- SRMC-Wound Care Professional Services
NPI Registry JSON
{
"created_epoch": "1219276800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1253836800000",
"number": "1780831776",
"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": "103 W 27TH ST",
"city": "LUMBERTON",
"state": "NC",
"postal_code": "283583014",
"telephone_number": "910-738-3836",
"fax_number": "910-738-3959"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SOUTHEASTERN REGIONAL MEDICAL CENTER",
"organizational_subpart": "NO",
"enumeration_date": "2008-08-21",
"last_updated": "2009-09-25",
"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_prefix": "Mr.",
"authorized_official_name_suffix": "III"
},
"taxonomies": [
{
"code": "302R00000X",
"taxonomy_group": "",
"desc": "Health Maintenance Organization",
"state": "NC",
"license": "H0064",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "020XY",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5950384",
"state": "NC"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "SRMC-Wound Care Professional Services",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Lumberton, NC
- Southeastern Regional Medical Center
- Southeastern Regional Medical Center
- Southeastern Regional Medical Center
- Southeastern Regional Medical Center
- Southeastern Regional Medical Center
- Southeastern Regional Medical Center
- Southeastern Regional Medical Center
- Southeastern Regional Medical Center
- Southeastern Regional Medical Center
- Southeastern Regional Medical Center
All providers in Lumberton, NC · Health Maintenance Organization 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 Sep 25, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.