Provider Demographics
NPI:1609011733
Name:CUMBERLAND RIVER HOSPITAL INC
Entity Type:Organization
Organization Name:CUMBERLAND RIVER HOSPITAL INC
Other - Org Name:CUMBERLAND RIVER HOSPITAL ER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CAO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRICIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:STRONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-243-3581
Mailing Address - Street 1:100 OLD JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:TN
Mailing Address - Zip Code:38551-4040
Mailing Address - Country:US
Mailing Address - Phone:931-243-3581
Mailing Address - Fax:931-243-5222
Practice Address - Street 1:100 OLD JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:TN
Practice Address - Zip Code:38551-4040
Practice Address - Country:US
Practice Address - Phone:931-243-3581
Practice Address - Fax:931-243-5222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-03
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207PE0004X
TN15282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0440141Medicaid
103G704239Medicare PIN
TN0440141Medicaid