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General NPI Number Information
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NPI Number | 1437105277
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Entity Type | Organization
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Legal Business Name | SOUTHEASTERN EMERGENCY PHYSICIANS OF MEMPHIS LLC
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Dates
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Enumeration Date | 05/25/2006
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Last Update Date | 09/29/2020
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Provider Practice Location Address
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Address Line | 1 MEMORIAL DR
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City | ALTON
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State | IL
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Zip | 62002-6722
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Country | US
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Telephone | 618-463-7474
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 633819
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City | CINCINNATI
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State | OH
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Zip | 45263-3819
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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 | MD
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Telephone | 865-293-5205
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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 | TN
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Taxonomy #2
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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 #3
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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 #4
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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 | TN
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