Healthcare Provider Details

I. General information

NPI: 1215070164
Provider Name (Legal Business Name): LAKE CUMBERLAND REGIONAL HOSPITAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 05/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 LANGDON ST
SOMERSET KY
42503-2750
US

IV. Provider business mailing address

305 LANGDON ST
SOMERSET KY
42503-2750
US

V. Phone/Fax

Practice location:
  • Phone: 606-451-2994
  • Fax: 606-451-2975
Mailing address:
  • Phone: 606-451-2994
  • Fax: 606-451-2975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT N KLEIN
Title or Position: DIVISION PRESIDENT
Credential:
Phone: 615-372-8500