MEDICARE: CUMBERLAND SURGICAL, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1083732119
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CUMBERLAND SURGICAL, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 3908
Second Line	:
City	:	CLARKSVILLE
State	:	TN
Zip	:	37043-0908
Country	:	US
Telephone Number	:	931-503-9007
Fax Number	:	931-572-0079

Provider Business Practice Location Address
First Line	:	273 DOVER RD
Second Line	:
City	:	CLARKSVILLE
State	:	TN
Zip	:	37042-4155
Country	:	US
Telephone Number	:	931-503-9007
Fax Number	:	931-572-0079

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	BETTY J ROSSON
Credential	:
Telephone Number	:	931-503-9007

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	08/25/2015

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