NPIMap

Organization Active NPI

Lake Cumberland Surgical Consultants PSC

  • Surgery Physician
  • Somerset, KY
National Provider Identifier
1801063698
Registry record updated Mar 5, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
LAKE CUMBERLAND SURGICAL CONSULTANTS PSC
Practice address
350 Hospital Way Ste 270
Somerset, KY 42503-1875
Phone
(606) 425-4298
Fax
(606) 425-4299
NPI assigned
May 12, 2008
Last updated
Mar 5, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Tommy Warren Shelton, MDNPI 1770617854
Title
Owner/Physician
Phone
(606) 425-4298

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X KY
Surgery Physician 208600000X KY Primary

Addresses

Primary practice location

350 Hospital Way Ste 270
Somerset, KY 42503-1875

Mailing address

350 Hospital Way Ste 270
Somerset, KY 42503-1875
Phone (606) 425-4298

Other identifiers 1

IdentifierTypeStateIssuer
7100052880 - MD GRPMedicaidKY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1210550400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1393977600000",
    "number": "1801063698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 HOSPITAL WAY STE 270",
            "city": "SOMERSET",
            "state": "KY",
            "postal_code": "425031875",
            "telephone_number": "606-425-4298",
            "fax_number": "606-425-4299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 HOSPITAL WAY STE 270",
            "city": "SOMERSET",
            "state": "KY",
            "postal_code": "425031875",
            "telephone_number": "606-425-4298",
            "fax_number": "606-425-4299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE CUMBERLAND SURGICAL CONSULTANTS PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-12",
        "last_updated": "2014-03-05",
        "status": "A",
        "authorized_official_last_name": "SHELTON",
        "authorized_official_first_name": "TOMMY",
        "authorized_official_middle_name": "WARREN",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "606-425-4298",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "KY",
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "KY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100052880 - MD GRP",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Somerset, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.