Basic Information
| Provider Information | |||||||||
| NPI: | 1801280672 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTHEASTERN HEALTH PHYSICIAN SERVICES | ||||||||
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| OtherOrganizationName: | LUMBERTON UROLOGY CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 815 OAKRIDGE BLVD | ||||||||
| Address2: | |||||||||
| City: | LUMBERTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283582330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9107387166 | ||||||||
| FaxNumber: | 9107384434 | ||||||||
| Practice Location | |||||||||
| Address1: | 815 OAKRIDGE BLVD | ||||||||
| Address2: | |||||||||
| City: | LUMBERTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283582330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9107387166 | ||||||||
| FaxNumber: | 9107384434 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2015 | ||||||||
| LastUpdateDate: | 03/19/2015 | ||||||||
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| AuthorizedOfficialLastName: | BRITT | ||||||||
| AuthorizedOfficialFirstName: | FORDHAM | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9106715026 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.