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General NPI Number Information
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NPI Number | 1538594668
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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 | 09/09/2013
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Last Update Date | 09/27/2017
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Provider Practice Location Address
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Address Line | 349 BOGLE ST SUITE A
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City | SOMERSET
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State | KY
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Zip | 42503-2895
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Country | US
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Telephone | 606-451-6060
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Fax | 606-678-4528
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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 | 606-451-6060
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Fax | 606-678-4528
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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 | 615-950-7514
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number |
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License Number State |
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