1356526156 NPI number — KRISTOPHER MICHAEL CUMBERMACK MD

Table of content: (NPI 1588874168)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356526156 NPI number — KRISTOPHER MICHAEL CUMBERMACK MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CUMBERMACK
Provider First Name:
KRISTOPHER
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CUMBERMACK
Provider Other First Name:
K.C.
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1356526156
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 ROSE STREET MN 150
Provider Second Line Business Mailing Address:
KENTUCKY CHILDREN'S HOSPITAL
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40536-0298
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-323-5494
Provider Business Mailing Address Fax Number:
859-323-3499

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 ROSE STREET MN 150
Provider Second Line Business Practice Location Address:
KENTUCKY CHILDREN'S HOSPITAL
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40536-0298
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-323-5494
Provider Business Practice Location Address Fax Number:
859-323-3499
Provider Enumeration Date:
12/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2080P0202X , with the licence number:  060362 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0202X , with the licence number: 44022 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com