Provider Demographics
NPI:1093092744
Name:LAKE CUMBERLAND REGIONAL HOSPITAL LLC
Entity Type:Organization
Organization Name:LAKE CUMBERLAND REGIONAL HOSPITAL LLC
Other - Org Name:LAKE CUMBERLAND SURGICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-920-7000
Mailing Address - Street 1:353 BOGLE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-2888
Mailing Address - Country:US
Mailing Address - Phone:606-451-6005
Mailing Address - Fax:606-678-2087
Practice Address - Street 1:353 BOGLE ST
Practice Address - Street 2:SUITE A
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-2888
Practice Address - Country:US
Practice Address - Phone:606-451-6005
Practice Address - Fax:606-678-2087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-09
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty