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General NPI Number Information
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NPI Number | 1831994235
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Entity Type | Organization
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Legal Business Name | UPPER CUMBERLAND RURAL HEALTH CLINIC PLLC
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Dates
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Enumeration Date | 02/18/2025
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Last Update Date | 02/18/2025
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Provider Practice Location Address
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Address Line | 165 SHELTON ST
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City | SPARTA
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State | TN
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Zip | 38583-1595
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Country | US
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Telephone | 931-739-8722
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Fax |
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Provider Business Mailing Address
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Address Line | 225 N WILLOW AVE STE 3
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City | COOKEVILLE
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State | TN
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Zip | 38501-2453
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. PUSHPENDRA K JAIN
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Credential | MD
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Telephone | 931-528-8899
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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