SOUTHEASTERN REGIONAL MEDICAL CENTER NPI 1710979430

NPI Information

NPI: 1710979430
Provider Name: SOUTHEASTERN REGIONAL MEDICAL CENTER

Doing Business As: ST PAULS MEDICAL CLINIC

Classification: Clinic/Center - 261QR1300X
Entity Type: Organization

Specialization: Rural Health

Address:
128 E BROAD ST
SAINT PAULS, NC
ZIP 28384
Phone: (910) 865-5955
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SOUTHEASTERN REGIONAL MEDICAL CENTER is a rural health clinic center in Saint Pauls, NC. SOUTHEASTERN REGIONAL MEDICAL CENTER NPI is 1710979430. The provider is registered as an organization entity type.
The provider Is Doing Business As St Pauls Medical Clinic.

The provider's business location address is:

128 E BROAD ST
SAINT PAULS, NC
ZIP 28384-610
Phone: (910) 865-5955
Fax: (910) 865-3055

The provider's authorized official is Charles Thomas Johnson .
The authorized official title is Cfo and has the following contact phone number (910) 671-5090.

The CLIA number assigned to this NPI record is 34D2168921 - federally qualified health center with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 8/18/2005 and was last updated on 1/27/2009.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QR1300X	Clinic/Center	Rural Health	H0064	NORTH CAROLINA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	343999A	MEDICAID	NORTH CAROLINA
2	343999	MEDICARE PIN	NORTH CAROLINA
3	343999C	MEDICAID	NORTH CAROLINA
4	343999	MEDICARE OSCAR/CERTIFICATION	NORTH CAROLINA
5	011MW	OTHER	NORTH CAROLINA	BLUE CROSS BLUE SHIELD

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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