Provider Demographics
NPI:1689858664
Name:CUMBERLAND OCCUPATIONAL AND URGENT CARE CENTER LLC
Entity Type:Organization
Organization Name:CUMBERLAND OCCUPATIONAL AND URGENT CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:A
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-787-1990
Mailing Address - Street 1:118 BROWN AVENUE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555
Mailing Address - Country:US
Mailing Address - Phone:931-787-1990
Mailing Address - Fax:931-787-1988
Practice Address - Street 1:118 BROWN AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-7739
Practice Address - Country:US
Practice Address - Phone:931-787-1990
Practice Address - Fax:931-787-1988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-26
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1506712Medicaid
TN4173499OtherBCBS
TNP00619459OtherRAILROAD MEDICARE
TNP00619459OtherRAILROAD MEDICARE