LAKE CUMBERLAND PEDIATRICS PLLC (NPI# 1518406859) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1518406859 |
| Entity Type | Organization |
| Organization Name | LAKE CUMBERLAND PEDIATRICS PLLC |
| Practice Address |
1215 N Main St Ste 2 N/a Monticello KY 42633 |
| Mailing Address |
Po Box 1737 N/a Monticello KY 42633-4737 |
| Practice Telephone | 6067530293 |
| Practice Fax Number | 6067530291 |
| Mailing Telephone | 6067530293 |
| Mailing Fax Number | 6067530291 |
| Enumeration Date | 2017-02-20 |
| Last Update Date | 2018-06-04 |
| Authorized Official Name | JOSEPH CLAY BROWN (OWNER) |
| Authorized Official Telephone | 6067530293 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians | ||
| N | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians | ||
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 261QR1300X |
Clinic/Center Specialization: Rural Health |
900327 | KY | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KY | MEDICARE PART A | 18-8969 | 01 |
| KY | NP GROUP MEDICAID | 7100462460 | 01 |
| KY | 7100447120 | 05 | |
| KY | RHC LIC | 900327 | 01 |
| Street Address |
1215 N MAIN ST STE 2 N/A |
| City | MONTICELLO |
| State | KY |
| Zip Code | 42633 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295196137 | Miranda Tompkins | Nurse Practitioner | 1215 N Main St Ste 2, Monticello, KY 42633-2900 | 2016-03-18 |
| 1851867139 | Emilee Burton Greenwood | Clinic/Center | 1215 N Main St Ste 2, Monticello, KY 42633-2900 | 2018-10-15 |
| 1942700976 | Amy Doris Edwards | Nurse Practitioner | 1215 N Main St Ste 2, Monticello, KY 42633-2900 | 2018-02-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457963431 | Morgan Dishman | Pharmacist | 126 Franklin Dr, Monticello, KY 42633 | 2020-08-20 |
| 1942847686 | Burgess Drug Store Inc. | Pharmacy | 1 S. Creek Dr., Ste. #122, Monticello, KY 42633 | 2019-12-02 |
| 1639729460 | Lake Cumberland Therapy Center, Inc. | Developmental Therapist | 153 High Street, Monticello, KY 42633 | 2019-09-13 |
| 1053964965 | Faith Healthcare Inc | Nurse Practitioner | 126 Franklin Drive, Monticello, KY 42633 | 2019-07-19 |
| 1669936621 | Alisa D Wallace | Case Manager/Care Coordinator | 803 Columbia Ave, Monticello, KY 42633 | 2019-01-24 |
| 1194232207 | Jacob Dudley Coffey | Nurse Practitioner | 1 S Creek Dr Ste 102606, Monticello, KY 42633 | 2018-01-10 |
| 1245581578 | Joleen Nyesa Levering | Pharmacist | 1078 North Main Streeet, Monticello, KY 42633 | 2012-09-26 |
| 1194085977 | Steven M Tallent II | Dentist | 1225 N. Main St., Brummett Cosmetic and Family Dentistry, Monticello, KY 42633 | 2012-05-25 |
| 1245376243 | Diagnostic Radiology of London | Specialist | 1455 E Hwy 90 By-pass Unit #4, Monticello, KY 42633 | 2007-01-29 |
| 1639241433 | Hicks Enterprises of Monticello, LLC | Nursing Facility/Intermediate Care Facility | 1801 W. Hwy. 90 By-pass, Monticello, KY 42633 | 2006-11-15 |
| Find all providers in zip 42633 | ||||
| Taxonomy Code | 261QR1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rural Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043716525 | Mmc Rural Health Clinics, Pllc | Clinic/Center | 733 Roberts Drive, Monticello, AR 71655 | 2018-04-03 |
| 1245289172 | Southwest Mississippi Regional Medical Center | Clinic/Center | 1167 E Broad St, Monticello, MS 39654-7682 | 2006-05-08 |
| 1851867139 | Emilee Burton Greenwood | Clinic/Center | 1215 N Main St Ste 2, Monticello, KY 42633-2900 | 2018-10-15 |
| 1558527259 | Kirby Medical Center | Clinic/Center | 1000 Medical Center Dr, Monticello, IL 61856-2116 | 2008-08-01 |
| 1700955317 | Mercy Physician Associates, Inc | Clinic/Center | 619 S Main St, Monticello, IA 52310-1733 | 2006-11-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669072757 | Arh Mary Breckinridge Health Services, Inc. | Clinic/Center | 302 Walnut Street, Pineville, KY 40977 | 2020-10-28 |
| 1316553167 | Flaget Healthcare Inc | Clinic/Center | 2387 Main St, Willisburg, KY 40078-8102 | 2020-09-17 |
| 1710590880 | Flaget Healthcare, Inc | Clinic/Center | 4359 Shepherdsville Road, Ste 255, Bardstown, KY 40004 | 2020-08-28 |
| 1649881335 | Emerald Therapy Center, LLC | Clinic/Center | 111 Poplar St, Murray, KY 42071-2571 | 2020-08-14 |
| 1407472319 | Family Health Care Associates 7 Limited Liability Company | Clinic/Center | 422 N Highway 27, Whitley City, KY 42653 | 2020-06-17 |
| 1154950699 | Family Health Care Associates 6 Limited Liability Company | Clinic/Center | 8070 Us Highway 60 W, Lewisport, KY 42351-7087 | 2020-04-06 |
| 1568098838 | Appalachian Regional Healthcare, Inc | Clinic/Center | 186 Breanna Blvd, Suite 100, Salyersville, KY 41465-7525 | 2020-03-19 |
| 1780217794 | Family Health Care Associates 5 Limited Liability Company | Clinic/Center | 74 H&b Partin Lane, Pineville, KY 40977 | 2020-02-18 |
| 1023649514 | Memorial Hospital Inc | Clinic/Center | 485 Memorial Dr Ste 1, Manchester, KY 40962-9111 | 2020-02-03 |
| 1265072946 | Baptist Health Medical Group Inc | Clinic/Center | 800 Hospital Dr Fl 2, Madisonville, KY 42431-1658 | 2020-01-10 |
| Find all providers with the same taxonomy | ||||
| City | MONTICELLO |
| Zip Code | 42633 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.