Healthcare Provider Details

I. General information

NPI: 1215931134
Provider Name (Legal Business Name): CUMBERLAND VALLEY SURGICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 HIGHWAY 770
CORBIN KY
40701-4732
US

IV. Provider business mailing address

275 HIGHWAY 770
CORBIN KY
40701-4732
US

V. Phone/Fax

Practice location:
  • Phone: 606-526-7874
  • Fax: 606-526-7836
Mailing address:
  • Phone: 606-526-7874
  • Fax: 606-526-7836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number300073
License Number StateKY

VIII. Authorized Official

Name: MRS. KIM TURNER
Title or Position: BUSINESS DIRECTOR
Credential:
Phone: 606-526-7874