Healthcare Provider Details

I. General information

NPI: 1275621690
Provider Name (Legal Business Name): CUMBERLAND MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 12/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 SOUTH MAIN STREET
CROSSVILLE TN
38555
US

IV. Provider business mailing address

421 SOUTH MAIN STREET
CROSSVILLE TN
38555
US

V. Phone/Fax

Practice location:
  • Phone: 931-484-9511
  • Fax: 931-707-2737
Mailing address:
  • Phone: 931-484-9511
  • Fax: 931-707-2737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0000000327
License Number StateTN

VIII. Authorized Official

Name: MR. LARRY EBERT
Title or Position: FINANCE DIRECTOR
Credential:
Phone: 931-459-7105