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Organization
LAKE CUMBERLAND PHYSICIAN PRACTICES LLC
Active
Organization
LAKE CUMBERLAND PHYSICIAN PRACTICES LLC
Active
Other names
Lake Cumberland Family Care
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY TEAGUE (SECRETARY / AUTHORIZED OFFICIAL)
(615) 920-7000
Entity
Organization
Contact information
Practice address
30 TOWER CIR, SOMERSET, KY 42503-3476
(606) 451-8644
(606) 451-9644
Mailing address
330 SEVEN SPRINGS WAY, BRENTWOOD, TN 37027
(615) 920-7000
(615) 920-8775
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
363A00000X
Physician Assistant
—
NULL
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
NULL
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
04/30/2011
Last updated
08/28/2019
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