Provider Demographics
NPI:1073704789
Name:LAKE CUMBERLAND REGIONAL HOSPITAL LLC
Entity Type:Organization
Organization Name:LAKE CUMBERLAND REGIONAL HOSPITAL LLC
Other - Org Name:ADVANCE LUNG & SLEEP CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-372-8500
Mailing Address - Street 1:350 HOSPITAL WAY
Mailing Address - Street 2:SUITE 250
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-2872
Mailing Address - Country:US
Mailing Address - Phone:606-678-0171
Mailing Address - Fax:606-678-2087
Practice Address - Street 1:350 HOSPITAL WAY
Practice Address - Street 2:SUITE 250
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-2872
Practice Address - Country:US
Practice Address - Phone:606-678-0171
Practice Address - Fax:606-678-2087
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAKE CUMBERLAND REGIONAL HOSPITAL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-07
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CG4101OtherRAILROAD - MEDICARE
KY00456Medicare PIN