Healthcare Provider Details

I. General information

NPI: 1164454450
Provider Name (Legal Business Name): SOUTHEASTERN EMERGENCY SERVICES OF MEMPHIS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 10/14/2020
Certification Date: 10/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 BLACKFORD ST
CHATTANOOGA TN
37403-1405
US

IV. Provider business mailing address

P O BOX 634811
CINCINNATI OH
45263-4811
US

V. Phone/Fax

Practice location:
  • Phone: 865-693-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. RANDAL L DABBS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 865-693-1000