Provider Demographics
NPI:1679641740
Name:MID CUMBERLAND INFECTIOUS DISEASE CONSULTANTS PLC
Entity Type:Organization
Organization Name:MID CUMBERLAND INFECTIOUS DISEASE CONSULTANTS PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SIMI
Authorized Official - Middle Name:
Authorized Official - Last Name:VINCENT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-551-9950
Mailing Address - Street 1:298 CLEAR SKY CT
Mailing Address - Street 2:SUITE D
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-5685
Mailing Address - Country:US
Mailing Address - Phone:931-551-9950
Mailing Address - Fax:931-551-9054
Practice Address - Street 1:298 CLEAR SKY CT
Practice Address - Street 2:SUITE D
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-5685
Practice Address - Country:US
Practice Address - Phone:931-551-9950
Practice Address - Fax:931-551-9054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35724174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty