Provider Demographics
NPI:1548318553
Name:LAKE CUMBERLAND NEUROSURGICAL CLINIC PSC
Entity type:Organization
Organization Name:LAKE CUMBERLAND NEUROSURGICAL CLINIC PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMR
Authorized Official - Middle Name:O
Authorized Official - Last Name:EL-NAGGAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-678-9617
Mailing Address - Street 1:75 HAIL KNOB RD
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-3434
Mailing Address - Country:US
Mailing Address - Phone:606-678-9617
Mailing Address - Fax:606-678-9619
Practice Address - Street 1:75 HAIL KNOB RD
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-3434
Practice Address - Country:US
Practice Address - Phone:606-678-9617
Practice Address - Fax:606-678-9619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3268Medicare PIN
KY6175980001Medicare NSC