Provider Demographics
NPI:1881083962
Name:SOUTHEASTERN TRANSITION AND PRIMARY CARE CLINIC
Entity type:Organization
Organization Name:SOUTHEASTERN TRANSITION AND PRIMARY CARE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:WILKINS
Authorized Official - Last Name:PARNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-737-3147
Mailing Address - Street 1:2901 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-2982
Mailing Address - Country:US
Mailing Address - Phone:910-737-3147
Mailing Address - Fax:910-671-5538
Practice Address - Street 1:2901 N ELM ST
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2982
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:SOUTHEASTERN REGIONAL PHYSICIAN SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care