# LAKE CUMBERLAND PHYSICIAN PRACTICES, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Cardiothoracic Surgical Associates of Lake Cumberland
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053550046
- **Authorized official:** SARA MILLER (DIRECTOR)
- **Authorized official phone:** (615) 920-7514

## Contact information

- **Practice address:** 120 TRADEPARK DR, SUITE B, SOMERSET, KY 42503-3454
- **Practice address phone:** (606) 451-0300
- **Practice address fax:** (606) 451-0595
- **Mailing address:** 120 TRADEPARK DR, SUITE B, SOMERSET, KY 42503-3454
- **Mailing address phone:** (606) 451-0300
- **Mailing address fax:** (606) 451-0595

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | — | NULL | Yes |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | — | — | Yes |
| 363AS0400X | Surgical Physician Assistant | — | NULL | — |
| 363AS0400X | Surgical Physician Assistant | — | — | — |

## Other

- **Enumeration date:** 02/13/2009
- **Last updated:** 09/27/2017