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General NPI Number Information
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NPI Number | 1407044217
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Entity Type | Organization
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Legal Business Name | BAPTIST PHYSICIANS SOUTHEAST, INC.
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Dates
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Enumeration Date | 10/05/2007
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Last Update Date | 09/25/2014
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Provider Practice Location Address
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Address Line | 1 TRILLIUM WAY
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City | CORBIN
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State | KY
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Zip | 40701-8426
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Country | US
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Telephone | 606-526-8131
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Fax | 606-528-8661
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Provider Business Mailing Address
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Address Line | PO BOX 1325
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City | CORBIN
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State | KY
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Zip | 40702-1325
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Country | US
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Telephone | 606-526-8131
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Fax | 606-528-8661
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | LARRY GRAY
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Credential |
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Telephone | 606-526-8131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 5263P
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 700214
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology 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 | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State | KY
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Taxonomy #9
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | 900027
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License Number State | KY
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Taxonomy #11
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #12
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #13
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #14
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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Taxonomy #15
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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