Organization
BAPTIST PHYSICIANS SOUTHEAST, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY GRAY (PRESIDENT/CEO)
(606) 526-8131
Entity
Organization
Contact information
Practice address
1 TRILLIUM WAY, CORBIN, KY 40701-8426
(606) 526-8131
(606) 528-8661
Mailing address
PO BOX 1325, CORBIN, KY 40702-1325
(606) 526-8131
(606) 528-8661
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
—
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207RG0100X
Gastroenterology Physician
—
—
207RH0003X
Hematology & Oncology Physician
—
—
207RP1001X
Pulmonary Disease Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
—
208600000X
Surgery Physician
—
—
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
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
Enumeration date
10/05/2007
Last updated
09/25/2014
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