Basic Information
| Provider Information | |||||||||
| NPI: | 1245514306 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CUMBERLAND SPINE & SPORT, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 98 | ||||||||
| Address2: | |||||||||
| City: | JAMESTOWN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 385560098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9318795864 | ||||||||
| FaxNumber: | 9318791402 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 S DUNCAN ST | ||||||||
| Address2: | |||||||||
| City: | JAMESTOWN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 385563009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9318795864 | ||||||||
| FaxNumber: | 9318791402 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2011 | ||||||||
| LastUpdateDate: | 10/06/2011 | ||||||||
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| AuthorizedOfficialLastName: | SMITH | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | D. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9318795864 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
No ID Information.