Provider Demographics
NPI:1164922480
Name:CUMBERLAND FAMILY MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:CUMBERLAND FAMILY MEDICAL CENTER, INC.
Other - Org Name:FAMILY DENTAL OF WHITLEY CITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:E
Authorized Official - Last Name:LOY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-858-6655
Mailing Address - Street 1:PO BOX 1080
Mailing Address - Street 2:360 KEEN STREET
Mailing Address - City:BURKESVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42717-1080
Mailing Address - Country:US
Mailing Address - Phone:270-858-6655
Mailing Address - Fax:270-858-4027
Practice Address - Street 1:19 MEDICAL LOOP
Practice Address - Street 2:SUITE 3
Practice Address - City:WHITLEY CITY
Practice Address - State:KY
Practice Address - Zip Code:42653-4382
Practice Address - Country:US
Practice Address - Phone:606-376-2976
Practice Address - Fax:888-960-2041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-13
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY700172261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100017280Medicaid