Healthcare Provider Details

I. General information

NPI: 1346261245
Provider Name (Legal Business Name): UPPER CUMBERLAND ONCOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 11/05/2009
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
38503-0827
US

V. Phone/Fax

Practice location:
  • Phone: 931-646-2497
  • Fax: 931-646-5757
Mailing address:
  • Phone: 931-783-2497
  • Fax: 931-783-5757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: ALGIS P SIDRYS
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 931-783-2497