Healthcare Provider Details

I. General information

NPI: 1558677765
Provider Name (Legal Business Name): CUMBERLAND FOOT AND ANKLE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2010
Last Update Date: 08/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

723 BURKESVILLE RD
ALBANY KY
42602-1654
US

IV. Provider business mailing address

117 TRADEPARK DR
SOMERSET KY
42503-3428
US

V. Phone/Fax

Practice location:
  • Phone: 606-679-2773
  • Fax: 606-679-4626
Mailing address:
  • Phone: 606-679-2773
  • Fax: 606-679-4626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN E MOORE
Title or Position: OWNER/PODIATRIST
Credential: DPM
Phone: 606-679-2773