| Organization Name: | SOUTHEASTERN REGIONAL MEDICAL CENTER |
| NPI Number: | 1710979430 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CHARLES THOMAS JOHNSON (CFO) |
| Mailing Address: | 128 E Broad St Saint Pauls |
| State: | NC US |
| Postal Code: | 283841610 |
| Phone Number: | 9108655955 |
| Fax Number: | 9108653055 |
| NPI Enumeration Date: | 08/18/2005 |
| NPI Last Update Date: | 01/27/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR1300X |
| License Number: | H0064 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rural Health |
| Taxonomy Definition: | |