Provider Demographics
NPI:1265465041
Name:CUMBERLAND BACK PAIN CLINIC PC
Entity Type:Organization
Organization Name:CUMBERLAND BACK PAIN CLINIC PC
Other - Org Name:MCMINNVILLE PAIN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SMOLENSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-591-1736
Mailing Address - Street 1:PO BOX 1226
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37065-1226
Mailing Address - Country:US
Mailing Address - Phone:615-591-1736
Mailing Address - Fax:615-591-1581
Practice Address - Street 1:480 NEAL ST STE 101
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-4073
Practice Address - Country:US
Practice Address - Phone:931-520-8104
Practice Address - Fax:931-525-6107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty