Provider Demographics
NPI:1821086505
Name:UPPER CUMBERLAND SURGICAL ASSOCIATE
Entity Type:Organization
Organization Name:UPPER CUMBERLAND SURGICAL ASSOCIATE
Other - Org Name:VAUGHN N. BARNARD, GEORGE IVEY, III, DALE DOUGLAS, KENNA WILLIAMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATE SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:VAUGHN
Authorized Official - Middle Name:N
Authorized Official - Last Name:BARNARD
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:931-528-6496
Mailing Address - Street 1:340 N CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-2421
Mailing Address - Country:US
Mailing Address - Phone:931-528-6496
Mailing Address - Fax:931-526-1878
Practice Address - Street 1:340 N CEDAR AVE
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2421
Practice Address - Country:US
Practice Address - Phone:931-528-6496
Practice Address - Fax:931-526-1878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-07
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD 7769208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3705964Medicare ID - Type Unspecified