| Organization Name: | SOUTHEASTERN REGIONAL PHYSICIAN SERVICES |
| NPI Number: | 1003244286 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | FORDHAM B. BRITT (DIRECTOR) |
| Mailing Address: | 4384 Fayetteville Rd Lumberton |
| State: | NC US |
| Postal Code: | 28358 |
| Phone Number: | 9107381141 |
| Fax Number: | 9107386011 |
| NPI Enumeration Date: | 10/24/2013 |
| NPI Last Update Date: | 12/10/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM1300X |
| License Number: | H0064 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Multi-Specialty |
| Taxonomy Definition: | |