Organization
LAKE CUMBERLAND SURGICAL CONSULTANTS PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TOMMY WARREN SHELTON MD (OWNER/PHYSICIAN)
(606) 425-4298
Entity
Organization
Contact information
Practice address
350 HOSPITAL WAY STE 270, SOMERSET, KY 42503-1875
(606) 425-4298
(606) 425-4299
Mailing address
350 HOSPITAL WAY STE 270, SOMERSET, KY 42503-1875
(606) 425-4298
(606) 425-4299
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
KY
363AS0400X
Surgical Physician Assistant
—
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100052880 - MD GRP
—
KY
Enumeration date
05/12/2008
Last updated
03/05/2014
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