Provider Demographics
NPI:1598821464
Name:UPPER CUMBERLAND OTOLARYNGOLOGY CLINIC, PC
Entity Type:Organization
Organization Name:UPPER CUMBERLAND OTOLARYNGOLOGY CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:D
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-520-5832
Mailing Address - Street 1:100 W 4TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-2448
Mailing Address - Country:US
Mailing Address - Phone:931-528-1575
Mailing Address - Fax:931-526-2962
Practice Address - Street 1:100 W 4TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2448
Practice Address - Country:US
Practice Address - Phone:931-528-1575
Practice Address - Fax:931-526-2962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2005687OtherBCBS
TN3378945Medicaid
TN3378945Medicare ID - Type Unspecified