Provider Demographics
NPI:1689994154
Name:CUMBERLAND BRAIN AND SPINE, PLLC
Entity Type:Organization
Organization Name:CUMBERLAND BRAIN AND SPINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:TALEGHANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-884-0001
Mailing Address - Street 1:5653 FRIST BLVD
Mailing Address - Street 2:STE 731
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-2066
Mailing Address - Country:US
Mailing Address - Phone:270-781-1772
Mailing Address - Fax:270-781-2212
Practice Address - Street 1:1641 SCOTTSVILLE RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-3244
Practice Address - Country:US
Practice Address - Phone:270-781-1772
Practice Address - Fax:270-781-2212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-08
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37599207T00000X
KY37636208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100104630Medicaid
KY01209Medicare PIN
KY6400670001Medicare NSC