Healthcare Provider Details

I. General information

NPI: 1003302423
Provider Name (Legal Business Name): UPPER CUMBERLAND MEDICAL CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2018
Last Update Date: 07/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 BROAD ST
BAXTER TN
38544-5117
US

IV. Provider business mailing address

PO BOX 175
BAXTER TN
38544-0175
US

V. Phone/Fax

Practice location:
  • Phone: 931-858-2116
  • Fax: 931-858-2117
Mailing address:
  • Phone: 931-858-2116
  • Fax: 931-858-2117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. JACQUELINE D SWALLOWS
Title or Position: NURSE PRACTITIONER
Credential: FNP
Phone: 931-858-2116