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
—
—
207R00000X
Internal Medicine Physician
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100173010
—
KY
Enumeration date
04/30/2011
Last updated
08/28/2019
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