Basic Information
| Provider Information | |||||||||
| NPI: | 1134676091 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UPPER CUMBERLAND MEDICAL ASSOCIATES, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 225 N WILLOW AVE | ||||||||
| Address2: | |||||||||
| City: | COOKEVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 385012335 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 225 N WILLOW AVE | ||||||||
| Address2: | |||||||||
| City: | COOKEVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 385012335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9315288899 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2016 | ||||||||
| LastUpdateDate: | 12/12/2016 | ||||||||
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| AuthorizedOfficialLastName: | JAIN | ||||||||
| AuthorizedOfficialFirstName: | PUSHPENDRA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9315288899 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.