Provider Demographics
NPI:1477941649
Name:SOUTHEASTERN ASC
Entity Type:Organization
Organization Name:SOUTHEASTERN ASC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:FORDHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BRITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-671-5026
Mailing Address - Street 1:2600 N. ELM ST
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358
Mailing Address - Country:US
Mailing Address - Phone:910-737-3147
Mailing Address - Fax:910-671-5538
Practice Address - Street 1:2600 N ELM ST
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-3011
Practice Address - Country:US
Practice Address - Phone:910-737-3147
Practice Address - Fax:910-671-5538
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHEASRERN PHYSICIANS SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-12-22
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical