Provider Demographics
NPI:1841424611
Name:LAKE CUMBERLAND PHYSICIAN PRACTICES, LLC
Entity Type:Organization
Organization Name:LAKE CUMBERLAND PHYSICIAN PRACTICES, LLC
Other - Org Name:PLASTIC SURGERY OF LAKE CUMBERLAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-920-7514
Mailing Address - Street 1:353 BOGLE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-2888
Mailing Address - Country:US
Mailing Address - Phone:606-451-3827
Mailing Address - Fax:606-451-3829
Practice Address - Street 1:353 BOGLE ST
Practice Address - Street 2:SUITE B
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-2888
Practice Address - Country:US
Practice Address - Phone:606-451-3827
Practice Address - Fax:606-451-3829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-08
Last Update Date:2017-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY01143Medicare PIN