1619039062 NPI number — CUMBERLAND RADIATION ASSOCIATES LLC

Table of content: (NPI 1619039062)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619039062 NPI number — CUMBERLAND RADIATION ASSOCIATES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CUMBERLAND RADIATION ASSOCIATES LLC
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:
1619039062
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/13/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
DEPT 0765
Provider Second Line Business Mailing Address:
PO BOX 11407
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35246-0765
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-383-3325
Provider Business Mailing Address Fax Number:
256-383-5911

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2114 N JACKSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TULLAHOMA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37388-2208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-454-9002
Provider Business Practice Location Address Fax Number:
931-454-9690
Provider Enumeration Date:
12/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WEEKS
Authorized Official First Name:
CRAIG
Authorized Official Middle Name:
M
Authorized Official Title or Position:
VICE PRESIDENT FINANCE
Authorized Official Telephone Number:
256-383-3325

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X , with the licence number:  MD25802 , 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)





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