Basic Information
| Provider Information | |||||||||
| NPI: | 1578600367 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LAKE CUMBERLAND WOMENS HEALTH SPECIALISTS,PSC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 333 BOGLE ST | ||||||||
| Address2: | |||||||||
| City: | SOMERSET | ||||||||
| State: | KY | ||||||||
| PostalCode: | 425032873 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6066780705 | ||||||||
| FaxNumber: | 6066782807 | ||||||||
| Practice Location | |||||||||
| Address1: | 333 BOGLE ST | ||||||||
| Address2: | |||||||||
| City: | SOMERSET | ||||||||
| State: | KY | ||||||||
| PostalCode: | 425032873 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6066780705 | ||||||||
| FaxNumber: | 6066782807 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2007 | ||||||||
| LastUpdateDate: | 04/24/2012 | ||||||||
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| AuthorizedOfficialLastName: | RUTLEDGE | ||||||||
| AuthorizedOfficialFirstName: | DALE | ||||||||
| AuthorizedOfficialMiddleName: | EDWARD | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN VP | ||||||||
| AuthorizedOfficialTelephone: | 6066780705 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | I | ||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LX0001X | KY | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Obstetrics & Gynecology | 207V00000X | KY | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.