Provider Demographics
NPI:1053301788
Name:CUMBERLAND CARDIOLOGY PSC
Entity Type:Organization
Organization Name:CUMBERLAND CARDIOLOGY PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:PAULUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-324-4743
Mailing Address - Street 1:PO BOX 2380
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-2380
Mailing Address - Country:US
Mailing Address - Phone:606-324-4745
Mailing Address - Fax:606-326-0165
Practice Address - Street 1:613 23RD ST
Practice Address - Street 2:STE 230
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2876
Practice Address - Country:US
Practice Address - Phone:606-324-4745
Practice Address - Fax:606-326-0165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-25
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RC0000X, 363L00000X
KYPA682363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810001838Medicaid
KY78903861Medicaid
OH0214155Medicaid
KY65926214Medicaid
WV3810001838Medicaid
KY65926214Medicaid
KY78903861Medicaid
WV9304112Medicare PIN