Provider Demographics
NPI:1346388246
Name:UPPER CUMBERLAND RURAL HEALTH CLINIC PLLC
Entity Type:Organization
Organization Name:UPPER CUMBERLAND RURAL HEALTH CLINIC PLLC
Other - Org Name:COOKEVILLE MEDICAL CLINIC RHC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PUSHPENDRA
Authorized Official - Middle Name:K
Authorized Official - Last Name:JAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-528-8899
Mailing Address - Street 1:225 N WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-2335
Mailing Address - Country:US
Mailing Address - Phone:931-528-8899
Mailing Address - Fax:931-284-4085
Practice Address - Street 1:225 N WILLOW AVE
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2335
Practice Address - Country:US
Practice Address - Phone:931-528-8899
Practice Address - Fax:931-284-4085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
TN443916261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN443916Medicare ID - Type Unspecified