Provider Demographics
NPI:1669440533
Name:CUMBERLAND MEDICAL LABORATORIES INC
Entity type:Organization
Organization Name:CUMBERLAND MEDICAL LABORATORIES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:MASON
Authorized Official - Last Name:MCMILLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-678-8800
Mailing Address - Street 1:PO BOX 3310
Mailing Address - Street 2:
Mailing Address - City:W SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42564
Mailing Address - Country:US
Mailing Address - Phone:606-678-8800
Mailing Address - Fax:606-679-5238
Practice Address - Street 1:401 BOGLE ST
Practice Address - Street 2:STE 205
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501
Practice Address - Country:US
Practice Address - Phone:606-678-8800
Practice Address - Fax:606-679-5238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-08
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20206207ZP0102X
KY200055291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical Laboratory
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY37902780Medicaid
KY7100158200Medicaid
KY37902780Medicaid
KY7100158200Medicaid