Provider Demographics
NPI:1578600367
Name:LAKE CUMBERLAND WOMENS HEALTH SPECIALISTS,PSC
Entity Type:Organization
Organization Name:LAKE CUMBERLAND WOMENS HEALTH SPECIALISTS,PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN VP
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:RUTLEDGE
Authorized Official - Suffix:I
Authorized Official - Credentials:MD
Authorized Official - Phone:606-678-0705
Mailing Address - Street 1:333 BOGLE ST
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-2873
Mailing Address - Country:US
Mailing Address - Phone:606-678-0705
Mailing Address - Fax:606-678-2807
Practice Address - Street 1:333 BOGLE ST
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-2873
Practice Address - Country:US
Practice Address - Phone:606-678-0705
Practice Address - Fax:606-678-2807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY207V00000X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY4100Medicare PIN