Healthcare Provider Details

I. General information

NPI: 1578557708
Provider Name (Legal Business Name): CUMBERLAND GI, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 05/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 CUMBERLAND FALLS HWY
CORBIN KY
40701-2727
US

IV. Provider business mailing address

1710 CUMBERLAND FALLS HWY
CORBIN KY
40701-2727
US

V. Phone/Fax

Practice location:
  • Phone: 606-528-6700
  • Fax: 606-528-6513
Mailing address:
  • Phone: 606-528-6700
  • Fax: 606-528-6513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL E SIMONS
Title or Position: OWNER/PRESIDENT
Credential: MD
Phone: 606-528-6700