Organization
LAKE CUMBERLAND REGIONAL HOSPITAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLOTTE LAWRENCE (SECRETARY)
(615) 920-7000
Entity
Organization
Contact information
Practice address
350 HOSPITAL WAY, SUITE 100, SOMERSET, KY 42503-2872
(606) 451-2619
(606) 451-2641
Mailing address
330 SEVEN SPRINGS WAY, BRENTWOOD, TN 37027-5098
(615) 920-7723
(615) 920-8775
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
208000000X
Pediatrics Physician
—
—
208600000X
Surgery Physician
—
—
261Q00000X
Clinic/Center
—
—
363A00000X
Physician Assistant
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
35001122
—
KY
01
—
5944
MEDICARE GROUP #
KY
05
—
65938151
—
KY
05
—
7100000970
—
KY
05
—
7100150140
—
KY
01
—
CG2357
RAILROAD MEDICARE
KY
01
—
CG4101
RAILROAD MEDICARE GROUP
KY
Enumeration date
10/16/2006
Last updated
10/07/2022
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