Provider Demographics
NPI:1184610859
Name:UPPER CUMBERLAND ORTHOPEDIC SURGERY, PC
Entity type:Organization
Organization Name:UPPER CUMBERLAND ORTHOPEDIC SURGERY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:A
Authorized Official - Last Name:EASTERLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-372-7716
Mailing Address - Street 1:105 S. WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501
Mailing Address - Country:US
Mailing Address - Phone:931-526-9518
Mailing Address - Fax:931-372-0087
Practice Address - Street 1:105 S. WILLOW AVE.
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501
Practice Address - Country:US
Practice Address - Phone:931-526-9518
Practice Address - Fax:931-372-0087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Multi-Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65942575Medicaid
TN3704956Medicaid
TN5475100001Medicare NSC
KY9354Medicare PIN
TN3704956Medicaid