1548770076 NPI number — CUMBERLAND FAMILY MEDICAL CENTER INC

Table of content: (NPI 1548770076)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548770076 NPI number — CUMBERLAND FAMILY MEDICAL CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CUMBERLAND FAMILY MEDICAL CENTER INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548770076
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/11/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1080
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BURKESVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42717-1080
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-864-1472
Provider Business Mailing Address Fax Number:
270-864-1693

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
127 FOOTHILLS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBANY
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42602-1037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-387-0047
Provider Business Practice Location Address Fax Number:
606-387-0083
Provider Enumeration Date:
10/11/2017

Additional Information

Authorized Official

Authorized Official Last Name:
AMONETT
Authorized Official First Name:
PHYLLIS
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING
Authorized Official Telephone Number:
270-864-1472

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , with the licence number:  700172 , 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)

  • Identifier: 7100017280 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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