NPIMap

Organization Active NPI

Southeastern Regional Medical Center

Doing business as SRMC-Wound Care Professional Services

  • Health Maintenance Organization
  • Lumberton, NC
National Provider Identifier
1780831776
Registry record updated Sep 25, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Maintenance OrganizationTaxonomy code 302R00000X
License
H0064 Issued in NC
Legal business name
SOUTHEASTERN REGIONAL MEDICAL CENTER
Doing business as
SRMC-Wound Care Professional Services
Practice address
103 W 27TH St
Lumberton, NC 28358-3014
Phone
(910) 738-3836
Fax
(910) 738-3959
NPI assigned
Aug 21, 2008
Last updated
Sep 25, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2009

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Maintenance Organization 302R00000X H0064 NC Primary

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 names 1

  • SRMC-Wound Care Professional Services 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": "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": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SRMC-Wound Care Professional Services",
            "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 Sep 25, 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.