Provider Demographics
NPI:1598820078
Name:CUMBERLAND OTOLARYNGOLOGY CONSULTANTS, PSC
Entity Type:Organization
Organization Name:CUMBERLAND OTOLARYNGOLOGY CONSULTANTS, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:T
Authorized Official - Last Name:KAVANAGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-679-7426
Mailing Address - Street 1:402 BOGLE ST STE 3
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-2870
Mailing Address - Country:US
Mailing Address - Phone:606-679-7426
Mailing Address - Fax:606-679-7745
Practice Address - Street 1:402 BOGLE ST STE 3
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-2870
Practice Address - Country:US
Practice Address - Phone:606-679-7426
Practice Address - Fax:606-679-7745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78901881Medicaid
KY65926917Medicaid
KY65926917Medicaid