Healthcare Provider Details

I. General information

NPI: 1275551731
Provider Name (Legal Business Name): SMOKY MOUNTAIN EMERGENCY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 10/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PAVILION DR
DANIELS WV
25832-9705
US

IV. Provider business mailing address

PO BOX 634711
CINCINNATI OH
45263-4711
US

V. Phone/Fax

Practice location:
  • Phone: 304-763-2888
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

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