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General NPI Number Information
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NPI Number | 1174091383
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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 | 11/06/2018
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Last Update Date | 11/06/2018
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Provider Practice Location Address
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Address Line | 56 TOWER CIR
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City | SOMERSET
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State | KY
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Zip | 42503-3476
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Country | US
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Telephone | 606-677-2913
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Fax | 616-677-6983
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Provider Business Mailing Address
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Address Line | 330 SEVEN SPRINGS WAY
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City | BRENTWOOD
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State | TN
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Zip | 37027-5098
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Country | US
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Telephone | 615-920-7000
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Fax | 615-920-8775
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Authorized Official
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Title or Position | SR. DIRECTOR
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Name | SHARLEE LEBLEU
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Credential |
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Telephone | 615-920-7192
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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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 | 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 #3
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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