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General NPI Number Information
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NPI Number | 1912720665
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Entity Type | Organization
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Legal Business Name | LAKE CUMBERLAND RHEUMATOLOGY PLLC
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Dates
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Enumeration Date | 11/01/2024
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Last Update Date | 11/01/2024
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Provider Practice Location Address
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Address Line | 101 PROSPEROUS PL STE 350
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City | LEXINGTON
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State | KY
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Zip | 40509-1891
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Country | US
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Telephone | 859-654-0160
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Fax | 859-712-9273
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Provider Business Mailing Address
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Address Line | 101 PROSPEROUS PL STE 350
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City | LEXINGTON
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State | KY
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Zip | 40509-1891
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Country | US
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Telephone | 859-654-0160
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Fax | 859-712-9273
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Authorized Official
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Title or Position | CEO
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Name | MR. MATT ROGERS
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Credential | MHA
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Telephone | 502-495-3665
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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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 | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number |
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License Number State |
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