Healthcare Provider Details

I. General information

NPI: 1437279262
Provider Name (Legal Business Name): CUMBERLAND IMAGING ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 W 5TH ST
COOKEVILLE TN
38501-1760
US

IV. Provider business mailing address

PO BOX 3262
INDIANAPOLIS IN
46206-3262
US

V. Phone/Fax

Practice location:
  • Phone: 931-528-2541
  • Fax: 931-526-8814
Mailing address:
  • Phone: 931-647-5034
  • Fax: 931-552-6663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD31227
License Number StateTN

VIII. Authorized Official

Name: JASON L HARDIN
Title or Position: PRESIDENT
Credential: MD
Phone: 931-528-2541