Healthcare Provider Details

I. General information

NPI: 1093901100
Provider Name (Legal Business Name): CUMBERLAND FOOT & ANKLE CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2007
Last Update Date: 03/16/2022
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 TRADEPARK DR STE B
SOMERSET KY
42503-3428
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 TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number StateKY

VIII. Authorized Official

Name: MS. MARTHA J LEE
Title or Position: OFFICE/BUSINESS MANAGER
Credential:
Phone: 606-679-2773