Provider Demographics
NPI:1063602670
Name:LAKE CUMBERLAND REGIONAL HOSPITAL, LLC
Entity type:Organization
Organization Name:LAKE CUMBERLAND REGIONAL HOSPITAL, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-372-8500
Mailing Address - Street 1:350 HOSPITAL WAY
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-2872
Mailing Address - Country:US
Mailing Address - Phone:606-451-0300
Mailing Address - Fax:
Practice Address - Street 1:350 HOSPITAL WAY
Practice Address - Street 2:SUITE 220
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-2872
Practice Address - Country:US
Practice Address - Phone:606-451-0300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAKE CUMBERLAND REGIONAL HOSPITAL, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-30
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00363Medicare PIN