Basic Information
| Provider Information | |||||||||
| NPI: | 1063602670 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LAKE CUMBERLAND REGIONAL HOSPITAL, LLC | ||||||||
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| OtherOrganizationName: | THE HEART AND LUNG INSTITUTE OF LAKE CUMBERLAND | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 350 HOSPITAL WAY | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | SOMERSET | ||||||||
| State: | KY | ||||||||
| PostalCode: | 425032872 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6064510300 | ||||||||
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| Practice Location | |||||||||
| Address1: | 350 HOSPITAL WAY | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | SOMERSET | ||||||||
| State: | KY | ||||||||
| PostalCode: | 425032872 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6064510300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2007 | ||||||||
| LastUpdateDate: | 10/17/2007 | ||||||||
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| AuthorizedOfficialLastName: | WEISS | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6153728500 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | LAKE CUMBERLAND REGIONAL HOSPITAL, LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
No ID Information.