Healthcare Provider Details

I. General information

NPI: 1629492772
Provider Name (Legal Business Name): UPPER CUMBERLAND ONCOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2014
Last Update Date: 02/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER BLVD
COOKEVILLE TN
38501-4294
US

IV. Provider business mailing address

PO BOX 827
COOKEVILLE TN
38503
US

V. Phone/Fax

Practice location:
  • Phone: 931-783-2477
  • Fax: 931-783-5757
Mailing address:
  • Phone: 931-783-2477
  • Fax: 931-783-5757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number29177
License Number StateTN

VIII. Authorized Official

Name: MARY A ARMS
Title or Position: BILLING MANAGER
Credential:
Phone: 931-783-2086