Provider Demographics
NPI:1083732119
Name:CUMBERLAND SURGICAL, PLLC
Entity Type:Organization
Organization Name:CUMBERLAND SURGICAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROSSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-503-9007
Mailing Address - Street 1:PO BOX 3908
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-0908
Mailing Address - Country:US
Mailing Address - Phone:931-503-9007
Mailing Address - Fax:931-572-0079
Practice Address - Street 1:273 DOVER RD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042-4155
Practice Address - Country:US
Practice Address - Phone:931-503-9007
Practice Address - Fax:931-572-0079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3370823Medicare ID - Type UnspecifiedMEDICARE
TN3370823Medicaid