Healthcare Provider Details

I. General information

NPI: 1780339838
Provider Name (Legal Business Name): CUMBERLAND FAMILY MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2022
Last Update Date: 02/17/2022
Certification Date: 02/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MYLYFE-KINGSFORD SUMMER SHADE 5126 SUMMER SHADE RD
SUMMER SHADE KY
42166-9701
US

IV. Provider business mailing address

PO BOX 1080
BURKESVILLE KY
42717-1080
US

V. Phone/Fax

Practice location:
  • Phone: 270-406-8805
  • Fax:
Mailing address:
  • Phone: 270-858-6655
  • Fax: 270-858-4607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: ERIC E LOY
Title or Position: CEO
Credential: MD
Phone: 270-858-6655