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General NPI Number Information
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NPI Number | 1356379382
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Entity Type | Organization
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Legal Business Name | SOUTHEASTERN EMERGENCY PHYSICIANS LLC
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Dates
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Enumeration Date | 06/29/2006
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Last Update Date | 02/08/2024
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Provider Practice Location Address
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Address Line | 989 MEDICAL PARK DR
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City | MAYSVILLE
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State | KY
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Zip | 41056-8750
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Country | US
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Telephone | 606-759-5311
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Fax |
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Provider Business Mailing Address
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Address Line | 265 BROOKVIEW CENTRE WAY STE 203
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City | KNOXVILLE
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State | TN
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Zip | 37919-4053
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Country | US
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Telephone | 888-203-1274
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL D CORVINI
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Credential | M.D.
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Telephone | 347-884-1707
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207PP0204X
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Taxonomy Name | Pediatric Emergency Medicine (Emergency Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2080P0204X
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Taxonomy Name | Pediatric Emergency Medicine (Pediatrics) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State | WV
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Taxonomy #5
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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