1275621690 NPI number — CUMBERLAND MEDICAL CENTER, INC.

Table of content: (NPI 1275621690)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275621690 NPI number — CUMBERLAND MEDICAL CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CUMBERLAND MEDICAL CENTER, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275621690
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
421 SOUTH MAIN STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CROSSVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38555
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
931-484-9511
Provider Business Mailing Address Fax Number:
931-707-2737

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
421 SOUTH MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CROSSVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38555
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-484-9511
Provider Business Practice Location Address Fax Number:
931-707-2737
Provider Enumeration Date:
10/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
EBERT
Authorized Official First Name:
LARRY
Authorized Official Middle Name:
Authorized Official Title or Position:
FINANCE DIRECTOR
Authorized Official Telephone Number:
931-459-7105

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  0000000327 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3056996 . This is a "BLUE CROSS PROFESSIONAL" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1000232 . This is a "BLUE CROSS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 223440009 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 026756100 . This is a "BLACK LUNG" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 0440009 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1000232 . This is a "TENNCARE SELECT AND BLUE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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