Healthcare Provider Details

I. General information

NPI: 1861042897
Provider Name (Legal Business Name): UPPER CUMBERLAND LABORATORY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2019
Last Update Date: 09/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1059 NEAL ST
COOKEVILLE TN
38501-0946
US

IV. Provider business mailing address

1059 NEAL ST
COOKEVILLE TN
38501-0946
US

V. Phone/Fax

Practice location:
  • Phone: 931-400-7246
  • Fax:
Mailing address:
  • Phone: 615-735-8002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: KATHRYN DUBRAY
Title or Position: ADMIN
Credential:
Phone: 615-735-8002