Provider Demographics
NPI:1366488199
Name:CUMBERLAND MEDICAL SUPPLY
Entity Type:Organization
Organization Name:CUMBERLAND MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:W.
Authorized Official - Middle Name:BLAINE
Authorized Official - Last Name:SHEFFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-654-8939
Mailing Address - Street 1:4383 STONEBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-3463
Mailing Address - Country:US
Mailing Address - Phone:850-654-8939
Mailing Address - Fax:850-654-8939
Practice Address - Street 1:4105 S CHARLESTON PIKE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45502-9375
Practice Address - Country:US
Practice Address - Phone:937-629-0962
Practice Address - Fax:937-629-0980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1455128Medicaid
WV3810008256Medicaid
KYR02256159Medicaid
PA101884075Medicaid
OH2052513Medicaid
IN100031700Medicaid
PA101884075Medicaid