Basic Information
| Provider Information | |||||||||
| NPI: | 1164585923 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CUMBERLAND NEUROLOGICAL AND SPINAL SURGERY | ||||||||
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| OtherOrganizationName: | TIER 1 NEUROSURGERY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 105 S WILLOW AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | COOKEVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 385014667 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9313727716 | ||||||||
| FaxNumber: | 9313727717 | ||||||||
| Practice Location | |||||||||
| Address1: | 105 S WILLOW AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | COOKEVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 385014667 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9313727716 | ||||||||
| FaxNumber: | 9313727717 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2006 | ||||||||
| LastUpdateDate: | 12/31/2012 | ||||||||
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| AuthorizedOfficialLastName: | FARGASON | ||||||||
| AuthorizedOfficialFirstName: | PAULA | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9313727716 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.