Healthcare Provider Details

I. General information

NPI: 1538337076
Provider Name (Legal Business Name): S E EMERGENCY PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2008
Last Update Date: 02/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 BROOKSHIRE LANE
BECKLEY WV
25801-6761
US

IV. Provider business mailing address

P O BOX 634706
CINCINNATI OH
45263-4706
US

V. Phone/Fax

Practice location:
  • Phone: 304-255-9205
  • Fax:
Mailing address:
  • Phone: 888-203-1274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RANDAL L DABBS
Title or Position: PRESIDENT
Credential: MD
Phone: 888-203-1274