Organization
SOUTHEASTERN EMERGENCY PHYSICIANS LLC
Active
Other names
SEP
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL D CORVINI M.D. (PRESIDENT)
(347) 884-1707
Entity
Organization
Contact information
Practice address
989 MEDICAL PARK DR, MAYSVILLE, KY 41056-8750
(606) 759-5311
Mailing address
265 BROOKVIEW CENTRE WAY STE 203, KNOXVILLE, TN 37919-4053
(888) 203-1274
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
207PP0204X
Pediatric Emergency Medicine (Emergency Medicine) Physician
—
—
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
—
—
208M00000X
Hospitalist Physician
—
—
291U00000X
Clinical Medical Laboratory
—
WV
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
363LP0200X
Pediatric Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001740238
MOUNTAIN STATES BLUE CROSS
WV
01
—
017E9
BCBS OF NC
NC
05
—
156473002
—
AR
05
—
157777002
—
AR
05
—
3728386
—
TN
05
—
4005131000
—
WV
05
—
507198802
—
MO
05
—
529931890
—
AL
05
—
5901815
—
NC
05
—
5902177
—
NC
01
—
5C346
BS AR
AR
05
—
65934218
—
KY
05
—
65937690
—
KY
05
—
GP3694
—
SC
05
—
GP3965
—
SC
Enumeration date
06/29/2006
Last updated
02/08/2024
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