Provider Demographics
NPI:1104878347
Name:SOUTHEASTERN NEPHROLOGY ASSOCIATES, PLLC
Entity type:Organization
Organization Name:SOUTHEASTERN NEPHROLOGY ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MURDOCH
Authorized Official - Last Name:HERION
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-343-9800
Mailing Address - Street 1:1302 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7503
Mailing Address - Country:US
Mailing Address - Phone:910-343-9800
Mailing Address - Fax:910-343-8650
Practice Address - Street 1:1302 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401
Practice Address - Country:US
Practice Address - Phone:910-343-9800
Practice Address - Fax:910-343-8650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89015CFMedicaid
NC890145QMedicaid
NC0227ROtherBC/BS NC GROUP
NC890227RMedicaid
NC=========004OtherTRICARE JACKSONVILLE GRP
NC89015CFMedicaid
NC0227ROtherBC/BS NC GROUP
NC890145QMedicaid
NC890227RMedicaid