Provider Demographics
NPI:1922248756
Name:CUMBERLAND KIDNEY SPECIALIST
Entity Type:Organization
Organization Name:CUMBERLAND KIDNEY SPECIALIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN / SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:ANJU
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDIRATTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-646-0880
Mailing Address - Street 1:117 N HICKORY AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-2424
Mailing Address - Country:US
Mailing Address - Phone:931-646-0880
Mailing Address - Fax:931-646-0884
Practice Address - Street 1:117 N HICKORY AVE STE 200
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2424
Practice Address - Country:US
Practice Address - Phone:931-646-0880
Practice Address - Fax:866-834-5618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-06
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RN0300X
TN040111261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty