# BAPTIST PHYSICIANS SOUTHEAST, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407044217
- **Authorized official:** LARRY GRAY (PRESIDENT/CEO)
- **Authorized official phone:** (606) 526-8131

## Contact information

- **Practice address:** 1 TRILLIUM WAY, CORBIN, KY 40701-8426
- **Practice address phone:** (606) 526-8131
- **Practice address fax:** (606) 528-8661
- **Mailing address:** PO BOX 1325, CORBIN, KY 40702-1325
- **Mailing address phone:** (606) 526-8131
- **Mailing address fax:** (606) 528-8661

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | — | NULL | — |
| 1041C0700X | Clinical Social Worker | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 207RC0000X | Cardiovascular Disease Physician | — | NULL | — |
| 207RC0000X | Cardiovascular Disease Physician | — | — | — |
| 207RG0100X | Gastroenterology Physician | — | NULL | — |
| 207RG0100X | Gastroenterology Physician | — | — | — |
| 207RH0003X | Hematology & Oncology Physician | — | NULL | — |
| 207RH0003X | Hematology & Oncology Physician | — | — | — |
| 207RP1001X | Pulmonary Disease Physician | — | NULL | — |
| 207RP1001X | Pulmonary Disease Physician | — | — | — |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | — |
| 207X00000X | Orthopaedic Surgery Physician | — | — | — |
| 2085R0202X | Diagnostic Radiology Physician | — | NULL | — |
| 2085R0202X | Diagnostic Radiology Physician | — | — | — |
| 208600000X | Surgery Physician | — | NULL | — |
| 208600000X | Surgery Physician | — | — | — |
| 208800000X | Urology Physician | — | NULL | — |
| 208800000X | Urology Physician | — | — | — |
| 261QP2300X | Primary Care Clinic/Center | 700214 | KY | — |
| 261QR1300X | Rural Health Clinic/Center | 900027 | KY | — |
| 363A00000X | Physician Assistant | — | KY | — |
| 363L00000X | Nurse Practitioner | 5263P | KY | — |

## Other

- **Enumeration date:** 10/05/2007
- **Last updated:** 09/25/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 7100027820 | — | KY |
| 01 | — | 7100097590 | MEDICAID NURSE PRACTITIONERS | KY |
| 01 | — | 7100221220 | MEDICAID PHYSICIAN ASSISTANTS | KY |
| 01 | — | 7100302310 | MEDICAID LCSW | KY |