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Organization
LAKE CUMBERLAND PHYSICIAN PRACTICES, LLC
Active
Organization
LAKE CUMBERLAND PHYSICIAN PRACTICES, LLC
Active
Other names
Lake Cumberland Urology Associates
Organization subpart
No
Provider details
NPI number
Authorized official
SARA MILLER (DIRECTOR)
(615) 920-7514
Entity
Organization
Contact information
Practice address
30 MEDPARK SQUARE, SUITE 1, SOMERSET, KY 42503-1709
(606) 451-0485
(606) 451-0229
Mailing address
PO BOX 719, SOMERSET, KY 42502-0719
(606) 451-0485
(606) 451-0229
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
NULL
208800000X
Urology Physician
Primary
—
—
363A00000X
Physician Assistant
—
NULL
363A00000X
Physician Assistant
—
—
Other
Enumeration date
09/22/2015
Last updated
09/27/2017
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