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General NPI Number Information
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NPI Number | 1164832531
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Entity Type | Organization
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Legal Business Name | LAKE CUMBERLAND PHYSICIAN PRACTICES, LLC
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Dates
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Enumeration Date | 05/06/2014
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Last Update Date | 09/27/2017
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Provider Practice Location Address
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Address Line | 72 JOE T PETTY DR
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City | RUSSELL SPRINGS
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State | KY
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Zip | 42642-8533
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Country | US
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Telephone | 270-866-7771
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Fax | 270-866-7774
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Provider Business Mailing Address
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Address Line | PO BOX 719
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City | SOMERSET
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State | KY
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Zip | 42502-0719
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Country | US
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Telephone | 270-866-7771
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Fax | 270-866-7774
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Authorized Official
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Title or Position | DIRECTOR
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Name | SARA MILLER
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Credential |
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Telephone | 615-920-7514
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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