Provider Demographics
NPI:1578557708
Name:CUMBERLAND GI, PSC
Entity Type:Organization
Organization Name:CUMBERLAND GI, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:SIMONS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-528-6700
Mailing Address - Street 1:1710 CUMBERLAND FALLS HWY
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-2727
Mailing Address - Country:US
Mailing Address - Phone:606-528-6700
Mailing Address - Fax:606-528-6513
Practice Address - Street 1:1710 CUMBERLAND FALLS HWY
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-2727
Practice Address - Country:US
Practice Address - Phone:606-528-6700
Practice Address - Fax:606-528-6513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-02
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65932063Medicaid
KY7100001390Medicaid
KY7100001390Medicaid
KY7100001390Medicaid
KY7100001390Medicaid
KY5756Medicare ID - Type Unspecified