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General NPI Number Information
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NPI Number | 1780805010
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Entity Type | Organization
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Legal Business Name | CUMBERLAND PLATEAU SURGICAL ASSOCIATES
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 621 N SPRING ST
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City | SPARTA
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State | TN
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Zip | 38583-1159
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Country | US
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Telephone | 931-738-9003
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Fax | 931-738-9085
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Provider Business Mailing Address
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Address Line | 621 N SPRING ST
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City | SPARTA
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State | TN
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Zip | 38583-1159
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Country | US
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Telephone | 931-738-9003
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Fax | 931-738-9085
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DONALD W PATE
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Credential | M.D.
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Telephone | 931-738-9003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | TN
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