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General NPI Number Information
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NPI Number | 1700198884
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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 | 07/06/2010
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Last Update Date | 09/27/2017
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Provider Practice Location Address
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Address Line | 353 BOGLE ST SUITE C
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City | SOMERSET
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State | KY
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Zip | 42503-2888
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Country | US
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Telephone | 606-678-2220
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Fax | 606-451-0595
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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
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Country | US
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Telephone | 615-920-7780
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Fax | 615-920-8775
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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 | 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 #2
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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 #3
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number |
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License Number State |
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