Basic Information
| Provider Information | |||||||||
| NPI: | 1285637090 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CUNNINGHAM PHYSICAL MEDICINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 880 GREENLEAF RD | ||||||||
| Address2: | |||||||||
| City: | COLDWATER | ||||||||
| State: | MS | ||||||||
| PostalCode: | 386188133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9012912400 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7601 SOUTHCREST PKWY | ||||||||
| Address2: | |||||||||
| City: | SOUTHAVEN | ||||||||
| State: | MS | ||||||||
| PostalCode: | 386714739 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9012912400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2005 | ||||||||
| LastUpdateDate: | 04/13/2015 | ||||||||
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| AuthorizedOfficialLastName: | CUNNINGHAM | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9012912400 | ||||||||
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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 | 208100000X | MD 16101 | TN | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 208100000X | MD 11905 | MS | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.