Provider Demographics
NPI:1164585923
Name:CUMBERLAND NEUROLOGICAL AND SPINAL SURGERY
Entity Type:Organization
Organization Name:CUMBERLAND NEUROLOGICAL AND SPINAL SURGERY
Other - Org Name:TIER 1 NEUROSURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:A
Authorized Official - Last Name:FARGASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-372-7716
Mailing Address - Street 1:105 S WILLOW AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-4667
Mailing Address - Country:US
Mailing Address - Phone:931-372-7716
Mailing Address - Fax:931-372-7717
Practice Address - Street 1:105 S WILLOW AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-4667
Practice Address - Country:US
Practice Address - Phone:931-372-7716
Practice Address - Fax:931-372-7717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3720925Medicare ID - Type UnspecifiedGROUP NUMBER
TN3720925Medicare PIN