# LAKE CUMBERLAND PHYSICIAN PRACTICES, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Russell County Medical Associates
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164832531
- **Authorized official:** SARA MILLER (DIRECTOR)
- **Authorized official phone:** (615) 920-7514

## Contact information

- **Practice address:** 72 JOE T PETTY DR, RUSSELL SPRINGS, KY 42642-8533
- **Practice address phone:** (270) 866-7771
- **Practice address fax:** (270) 866-7774
- **Mailing address:** PO BOX 719, SOMERSET, KY 42502-0719
- **Mailing address phone:** (270) 866-7771
- **Mailing address fax:** (270) 866-7774

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 05/06/2014
- **Last updated:** 09/27/2017