Healthcare Provider Details

I. General information

NPI: 1013055912
Provider Name (Legal Business Name): COOKEVILLE MEDICAL CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 N WILLOW AVE
COOKEVILLE TN
38501-2335
US

IV. Provider business mailing address

225 N WILLOW AVE
COOKEVILLE TN
38501-2335
US

V. Phone/Fax

Practice location:
  • Phone: 931-528-8899
  • Fax: 866-813-8531
Mailing address:
  • Phone: 931-528-8899
  • Fax: 866-813-8531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: DR. PUSHPENDRA K JAIN
Title or Position: CEO
Credential: M.D.
Phone: 931-528-8899