Provider Demographics
NPI:1275621690
Name:CUMBERLAND MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:CUMBERLAND MEDICAL CENTER, INC.
Other - Org Name:CUMBERLAND MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:EBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-459-7105
Mailing Address - Street 1:421 SOUTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555
Mailing Address - Country:US
Mailing Address - Phone:931-484-9511
Mailing Address - Fax:931-707-2737
Practice Address - Street 1:421 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555
Practice Address - Country:US
Practice Address - Phone:931-484-9511
Practice Address - Fax:931-707-2737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000327314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3056996OtherBLUE CROSS PROFESSIONAL
TN1000232OtherBLUE CROSS
TN223440009OtherRAILROAD MEDICARE
TN026756100OtherBLACK LUNG
TN0440009Medicaid
TN1000232OtherTENNCARE SELECT AND BLUE
TN1000232OtherBLUE CROSS
TN1000232OtherBLUE CROSS
TN3277919Medicare ID - Type UnspecifiedCIGNA MEDICARE