Southeastern Emergency Services P C
Organization Active NPI Nurse Practitioner · Athens, TN
NPI 1669414264 · NPPES record last updated Sep 14, 2020
Key facts
- NPI
- 1669414264
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Nurse Practitioner 363L00000X
- Legal business name
- SOUTHEASTERN EMERGENCY SERVICES P C
- Practice address
- 1114 W Madison Ave
Athens, TN 37371 - Phone
- (423) 745-1411
- NPI assigned
- Jun 11, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Randal L Dabbs, M.D.
- Title
- President
- Phone
- (865) 693-1000
Practitioners 501
-
Michelle N Albonetti Walker, F.N.P.
-
Joshua Aaron Barnes, FNP
-
Dona Maria Biggs, APRN FNP-C
-
Azra Blazevic, NP
-
John Paul Bradley, FNP
-
Hannah Elizabeth Brown, APRN-BC
-
Anna Kathleen Carden, FNP-C
-
Angela Marie Coates, MSN,NP-C
-
Jerry Coleman II, N.P
-
Charles Darrin Compton, N.P.
-
Ashley Sloan Condo, RN, FNP
-
Pamela Crues, NP
-
Ashlea Brooke Daniel, APN
-
Andrea Dishner, NP
-
Linda L. Funk, NP
-
Holly Gadd, NP
-
Michael D Gooch, DNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031121000687 | TN | Part B Supplier - Clinic/Group Practice | 6204730195 |
Receives reassigned benefits from 232 practitioners Practice locations: Lenoir City, TN; Memphis, TN; Nashville, TN; Oak Ridge, TN; Sevierville, TN; Winchester, TN; Knoxville, TN; Jellico, TN… |
National Provider Directory
Locations
1224 Trotwood Ave
Columbia, TN 38401
Phone (931) 380-4072
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Emergency Medicine (Emergency Medicine) Physician |
207PP0204X | |||
| Physician Assistant |
363A00000X | |||
| Medical Physician Assistant |
363AM0700X | |||
| Nurse Practitioner |
363L00000X | Yes | ||
| Nurse Practitioner |
363L00000X | TN | ||
| Pediatric Nurse Practitioner |
363LP0200X | TN |
Addresses
Primary practice location
1114 W Madison Ave
Athens, TN 37371
Mailing address
P O Box 634760
Cincinnati, OH 45263-4760
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2348298 | Medicaid | NC | |
| 05515899 | Medicaid | MS | |
| 507432003 | Medicaid | MO | |
| GP4818 | Medicaid | SC | |
| 02121280 | Medicaid | MS | |
| 529929400 | Medicaid | AL | |
| 78903671 | Medicaid | KY | |
| 06310389 | Medicaid | MS | |
| 7100010470 | Medicaid | KY |
Other providers in Athens, TN
- Trinity Smith
- Jylann Mary Sneed
- Rebecca Dawn Sneed
- Katie Kristine Sohler
- Anthony Sopczak
- Southern Orthocare, Inc
- Staar Labs
- Star Valley Pharmacy
- Chadwick Starkey
- Thomas Steele
All providers in Athens, TN · Nurse Practitioner in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 14, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.