Provider Demographics
NPI:1225161227
Name:CUMBERLAND PHYSICIAN GROUP, LLC
Entity Type:Organization
Organization Name:CUMBERLAND PHYSICIAN GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT/CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:VONACHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-459-7200
Mailing Address - Street 1:421 S MAIN ST # 231
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-5048
Mailing Address - Country:US
Mailing Address - Phone:931-459-7012
Mailing Address - Fax:931-510-5702
Practice Address - Street 1:421 S MAIN ST # 231
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-5048
Practice Address - Country:US
Practice Address - Phone:931-459-7012
Practice Address - Fax:931-510-5702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3370067Medicare PIN