Basic Information
| Provider Information | |||||||||
| NPI: | 1194921296 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CUMBERLAND BRAIN & SPINE, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5653 FRIST BLVD | ||||||||
| Address2: | STE 731 | ||||||||
| City: | HERMITAGE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370762066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8667811772 | ||||||||
| FaxNumber: | 6158840009 | ||||||||
| Practice Location | |||||||||
| Address1: | 5653 FRIST BLVD | ||||||||
| Address2: | STE 731 | ||||||||
| City: | HERMITAGE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370762066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8667811772 | ||||||||
| FaxNumber: | 6158840009 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2007 | ||||||||
| LastUpdateDate: | 07/19/2013 | ||||||||
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| AuthorizedOfficialLastName: | TALEGHANI | ||||||||
| AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER-NEUROSURGEON | ||||||||
| AuthorizedOfficialTelephone: | 6158840001 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0000X | 37636 | KY | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | 207T00000X | MD0000036852 | TN | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | 64060767 | 05 | KY | MEDICAID |