# LAKE CUMBERLAND PHYSICIAN PRACTICES, LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Lake Cumberland Urology Associates
- **Organization subpart:** No

## Provider details

- **NPI number:** 1982073813
- **Authorized official:** SARA MILLER (DIRECTOR)
- **Authorized official phone:** (615) 920-7514

## Contact information

- **Practice address:** 30 MEDPARK SQUARE, SUITE 1, SOMERSET, KY 42503-1709
- **Practice address phone:** (606) 451-0485
- **Practice address fax:** (606) 451-0229
- **Mailing address:** PO BOX 719, SOMERSET, KY 42502-0719
- **Mailing address phone:** (606) 451-0485
- **Mailing address fax:** (606) 451-0229

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208800000X | Urology Physician | — | NULL | Yes |
| 208800000X | Urology Physician | — | — | Yes |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |

## Other

- **Enumeration date:** 09/22/2015
- **Last updated:** 09/27/2017