Provider Demographics
NPI:1902228075
Name:CUMBERLAND FAMILY MEDICAL CENTER INC
Entity Type:Organization
Organization Name:CUMBERLAND FAMILY MEDICAL CENTER INC
Other - Org Name:D/B/A CASEY FAMILY MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
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 2399
Mailing Address - Street 2:
Mailing Address - City:RUSSELL SPRINGS
Mailing Address - State:KY
Mailing Address - Zip Code:42642-2399
Mailing Address - Country:US
Mailing Address - Phone:270-858-6655
Mailing Address - Fax:270-858-4027
Practice Address - Street 1:428 HUSTONVILLE STREET
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:KY
Practice Address - Zip Code:42539-3140
Practice Address - Country:US
Practice Address - Phone:606-787-0180
Practice Address - Fax:606-787-0104
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CUMBERLAND FAMILY MEDICAL CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-09
Last Update Date:2024-03-28
Deactivation Date:2022-04-08
Deactivation Code:
Reactivation Date:2023-12-12
Provider Licenses
StateLicense IDTaxonomies
KY261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Single Specialty