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General NPI Number Information
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NPI Number | 1841798741
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Entity Type | Organization
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Legal Business Name | CUMBERLAND FOOT AND ANKLE CENTERS
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Dates
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Enumeration Date | 01/25/2018
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Last Update Date | 01/25/2018
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Provider Practice Location Address
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Address Line | 466 BURNLEY RD
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City | SCOTTSVILLE
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State | KY
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Zip | 42164-6355
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Country | US
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Telephone | 270-846-3338
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Fax | 270-846-3318
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Provider Business Mailing Address
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Address Line | 117 TRADEPARK DR STE B
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City | SOMERSET
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State | KY
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Zip | 42503-3428
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Country | US
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Telephone | 606-679-2773
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Fax | 606-679-4626
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Authorized Official
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Title or Position | PRESIDENT/PODIATRIST
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Name | JONATHAN E MOORE
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Credential | DPM
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Telephone | 606-679-2773
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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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 #3
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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