Organization
LAKE CUMBERLAND PHYSICIAN PRACTICES LLC
Active
Other names
Sports Medicine and Orthopaedic Center of Lake Cumberland
Organization subpart
No
Provider details
NPI number
Authorized official
SARA MILLER (DIRECTOR)
(615) 920-7514
Entity
Organization
Contact information
Practice address
353 BOGLE ST, SUITE C, SOMERSET, KY 42503-2888
(606) 678-2220
(606) 451-0595
Mailing address
330 SEVEN SPRINGS WAY, BRENTWOOD, TN 37027
(615) 920-7780
(615) 920-8775
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
—
—
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
363A00000X
Physician Assistant
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100136480
—
KY
Enumeration date
07/06/2010
Last updated
09/27/2017
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