Healthcare Provider Details

I. General information

NPI: 1619117058
Provider Name (Legal Business Name): LAKE CUMBERLAND RHEUMATOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2009
Last Update Date: 04/28/2023
Certification Date: 04/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 OXFORD WAY STE A
SOMERSET KY
42503-2813
US

IV. Provider business mailing address

26 OXFORD WAY STE A
SOMERSET KY
42503-2813
US

V. Phone/Fax

Practice location:
  • Phone: 606-802-2300
  • Fax: 502-874-5536
Mailing address:
  • Phone: 606-802-2300
  • Fax: 502-874-5536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY ALLEN LONESKY
Title or Position: DO/OWNER
Credential: DO
Phone: 304-415-5155