Organization
SOUTHERN MEDICAL PARTNERS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISHA C FALK (VP OF CONTRACTING)
(337) 609-1221
Entity
Organization
Contact information
Practice address
100 MEDICAL CENTER DRIVE, HAZARD, KY 41701-9421
(606) 439-6651
(904) 805-1312
Mailing address
200 CORPORATE BLVD, LAFAYETTE, LA 70508-3870
(800) 893-9698
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
363LC0200X
Critical Care Medicine Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000061316
BCBS
KY
05
—
65930216
—
KY
Enumeration date
06/07/2006
Last updated
09/28/2022
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