Healthcare Provider Details

I. General information

NPI: 1548403991
Provider Name (Legal Business Name): CUMBERLAND ORTHOPAEDIC & SPORTS MEDICINE-ARNP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2009
Last Update Date: 04/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 LONDON MOUNTAIN VIEW DR
LONDON KY
40741-6601
US

IV. Provider business mailing address

160 LONDON MOUNTAIN VIEW DR
LONDON KY
40741-6601
US

V. Phone/Fax

Practice location:
  • Phone: 606-864-0770
  • Fax: 606-864-1461
Mailing address:
  • Phone: 606-864-0770
  • Fax: 606-864-1461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. JEAN M PAGE'
Title or Position: PRESIDENT OWNER
Credential: M.D.
Phone: 606-864-0770