Basic Information
| Provider Information | |||||||||
| NPI: | 1497746721 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CUMBERLAND MEDICAL CENTER, INC. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | CMC MEDICAL EQUIPMENT SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 591 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | CROSSVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 385555009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9314848076 | ||||||||
| FaxNumber: | 9314842393 | ||||||||
| Practice Location | |||||||||
| Address1: | 591 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | CROSSVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 385555009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9314848076 | ||||||||
| FaxNumber: | 9314842393 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MCMACKIN | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | LEON | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9314849511 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BX2000X | 0000000398 | TN | Y | Suppliers | Durable Medical Equipment & Medical Supplies | Oxygen Equipment & Supplies |
ID Information
| ID | Type | State | Issuer | Description | 3547142 | 05 | TN | MEDICAID |