Provider Demographics
NPI:1346261245
Name:UPPER CUMBERLAND ONCOLOGY
Entity Type:Organization
Organization Name:UPPER CUMBERLAND ONCOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALGIS
Authorized Official - Middle Name:P
Authorized Official - Last Name:SIDRYS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-783-2497
Mailing Address - Street 1:PO BOX 827
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38503-0827
Mailing Address - Country:US
Mailing Address - Phone:931-783-2497
Mailing Address - Fax:931-783-5757
Practice Address - Street 1:1 MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-4294
Practice Address - Country:US
Practice Address - Phone:931-646-2497
Practice Address - Fax:931-646-5757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3733318Medicaid
TN3733318Medicaid