Provider Demographics
NPI:1972911030
Name:SOUTHEASTERN AMBULATORY SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:SOUTHEASTERN AMBULATORY SURGERY CENTER, LLC
Other - Org Name:THE SURGERY CENTER AT SOUTHEASTERN HEALTH PARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:REVELS
Authorized Official - Last Name:LOCKLEAR
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:910-887-2361
Mailing Address - Street 1:4901 DAWN DR
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28360-8207
Mailing Address - Country:US
Mailing Address - Phone:910-887-2361
Mailing Address - Fax:910-887-2370
Practice Address - Street 1:4901 DAWN DR
Practice Address - Street 2:SUITE 1100
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28360-8207
Practice Address - Country:US
Practice Address - Phone:910-887-2361
Practice Address - Fax:910-887-2370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-31
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical