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General NPI Number Information
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NPI Number | 1689858664
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Entity Type | Organization
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Legal Business Name | CUMBERLAND OCCUPATIONAL AND URGENT CARE CENTER LLC
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Dates
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Enumeration Date | 12/26/2007
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Last Update Date | 10/13/2008
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Provider Practice Location Address
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Address Line | 118 BROWN AVE SUITE 102
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City | CROSSVILLE
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State | TN
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Zip | 38555-7739
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Country | US
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Telephone | 931-787-1990
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Fax | 931-787-1988
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Provider Business Mailing Address
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Address Line | 118 BROWN AVENUE SUITE 102
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City | CROSSVILLE
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State | TN
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Zip | 38555
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Country | US
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Telephone | 931-787-1990
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Fax | 931-787-1988
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Authorized Official
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Title or Position | OWNER
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Name | JON A SIMPSON
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Credential | M.D.
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Telephone | 931-787-1990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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