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Southeastern Physician Services PC

Organization Active NPI Hospitalist Physician · Oak Ridge, TN

NPI 1083835441 · NPPES record last updated Jan 31, 2020

Key facts

NPI
1083835441
Entity type
Organization (NPI type 2)
Primary specialty
Hospitalist Physician 208M00000X
Legal business name
SOUTHEASTERN PHYSICIAN SERVICES PC
Practice address
990 Oak Ridge Tpke
Oak Ridge, TN 37830-6976
Phone
(865) 481-1000
NPI assigned
May 2, 2007
Organization subpart
No

Authorized official

Name
Dr. Randal L Dabbs, MD
Title
President
Phone
(888) 203-1274

Practitioners 1,862

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 1,862

Medicare participation

Medicare fee-for-service enrollment
Enrolled (5 enrollments) in TN, VA, KY, MO, MS

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20071025000571 TN Part B Supplier - Clinic/Group Practice 0042307852 Receives reassigned benefits from 1,105 practitioners
O20081229000558 VA Part B Supplier - Clinic/Group Practice 0042307852 Receives reassigned benefits from 63 practitioners
Practice locations: Wytheville, VA; Wise, VA; Abingdon, VA; Weber City, VA; Richmond, VA; Lebanon, VA; Grundy, VA; Duffield, VA…
O20090715000150 KY Part B Supplier - Clinic/Group Practice 0042307852 Receives reassigned benefits from 390 practitioners
Practice locations: Paducah, KY; Maysville, KY; Madisonville, KY; Lexington, KY; Horse Cave, KY; Hartford, KY; Glasgow, KY; Flemingsburg, KY…
O20160809000235 MO Part B Supplier - Clinic/Group Practice 0042307852 Receives reassigned benefits from 204 practitioners
Practice locations: Saint Peters, MO; Saint Louis, MO; O Fallon, MO; Ferguson, MO
O20160831001321 MS Part B Supplier - Clinic/Group Practice 0042307852 Receives reassigned benefits from 1 practitioner
Practice locations: Grenada, MS; Holly Springs, MS; Southaven, MS

National Provider Directory

Locations

717 N Lincoln Blvd
Hodgenville, KY 42748
Phone (270) 356-3103

1099 Medical Center Cir
Mayfield, KY 42066
Phone (270) 251-4100

1501 S Dixie St
Park, KY 42749
Phone (270) 745-1255

10954 Kennerly Rd
Saint Louis, MO 63128
Phone (314) 843-4242

3715 Saint Anns Ln
Saint Louis, MO 63121
Phone (314) 383-3353

55 Nursing Home Rd
Chuckey, TN 37641
Phone (423) 257-6761

1666 Hillview Dr
Elizabethton, TN 37643
Phone (423) 542-5061

458 Hannings Ln
Martin, TN 38237
Phone (731) 558-2830

215 Richardson Way
Maynardville, TN 37807
Phone (423) 992-5816

204 Industrial Park Ln
Rocky Top, TN 37769
Phone (865) 426-2141

574 Cummings St
Abingdon, VA 24210
Phone (276) 623-8330

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207R00000X TN
Orthopaedic Surgery Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207X00000X
Hospitalist Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 208M00000X TN Yes
Adult Mental Health Clinic/Center 261QM0850X
Physician Assistant
Group: 193200000X MULTI-SPECIALTY GROUP		 363A00000X TN
Medical Physician Assistant
Group: 193200000X MULTI-SPECIALTY GROUP		 363AM0700X
Nurse Practitioner
Group: 193200000X MULTI-SPECIALTY GROUP		 363L00000X TN

Addresses

Primary practice location

990 Oak Ridge Tpke
Oak Ridge, TN 37830-6976

Mailing address

PO Box 635705
Cincinnati, OH 45263-5705
Phone (888) 203-1274

Other practice location 1

1100 Brookhaven Rd
Franklin, KY 42134-2746
Phone (270) 745-1212

Other identifiers

IdentifierTypeStateIssuer
3370208MedicaidTN
GP5012MedicaidSC
7100046370MedicaidKY
529932974MedicaidAL
5950338MedicaidNC

Other providers in Oak Ridge, TN

All providers in Oak Ridge, TN · Hospitalist Physician in Tennessee

Sources for this page

Verify at the official NPI Registry.