Organization
LAKE CUMBERLAND PEDIATRICS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH CLAY BROWN MD (OWNER)
(606) 753-0293
Entity
Organization
Contact information
Practice address
268 ROLLING HILLS BLVD., MONTICELLO, KY 42633-9004
(606) 753-0293
(606) 753-0291
Mailing address
PO BOX 1737, N/A, MONTICELLO, KY 42633-4737
(606) 753-0293
(606) 753-0291
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
208000000X
Pediatrics Physician
—
—
261QR1300X
Rural Health Clinic/Center
Primary
900327
KY
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18-8969
MEDICARE PART A
KY
05
—
7100447120
—
KY
01
—
7100462460
NP GROUP MEDICAID
KY
01
—
900327
RHC LIC
KY
Enumeration date
02/20/2017
Last updated
05/27/2022
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