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General NPI Number Information
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NPI Number | 1710919980
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Entity Type | Organization
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Legal Business Name | UPPER CUMBERLAND ANESTHESIA ASSOCIATES, PC
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 04/14/2020
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Provider Practice Location Address
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Address Line | 1 MEDICAL CENTER BLVD
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City | COOKEVILLE
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State | TN
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Zip | 38501-4294
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Country | US
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Telephone | 931-528-5587
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 280
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City | COOKEVILLE
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State | TN
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Zip | 38503-0280
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Country | US
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Telephone | 931-528-7877
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT HARRISON LANDRY
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Credential | MD
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Telephone | 931-528-7877
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State |
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