Healthcare Provider Details

I. General information

NPI: 1073802682
Provider Name (Legal Business Name): UPPER CUMBERLAND MOBILE IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2011
Last Update Date: 04/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

291 LAKE LN
COOKEVILLE TN
38506-7936
US

IV. Provider business mailing address

291 LAKE LN
COOKEVILLE TN
38506-7936
US

V. Phone/Fax

Practice location:
  • Phone: 931-267-0901
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JESSIE HITCHCOCK
Title or Position: ULTRASONOGRAPHER
Credential:
Phone: 931-267-0901