Healthcare Provider Details

I. General information

NPI: 1801034269
Provider Name (Legal Business Name): CUMBERLAND ANESTHESIA GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2009
Last Update Date: 01/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 S MAIN ST
CROSSVILLE TN
38555-5048
US

IV. Provider business mailing address

PO BOX 2297
ASHEVILLE NC
28802-2297
US

V. Phone/Fax

Practice location:
  • Phone: 931-459-7160
  • Fax:
Mailing address:
  • Phone: 828-210-9386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: KENNETH R ELLINGTON
Title or Position: PRESIDENT
Credential: MD
Phone: 864-591-1540