Provider Demographics
NPI:1356427462
Name:CUMBERLAND RIVER HOSPITAL INC
Entity type:Organization
Organization Name:CUMBERLAND RIVER HOSPITAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:PARICIA
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:STRONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-243-3581
Mailing Address - Street 1:100 OLD JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:TN
Mailing Address - Zip Code:38551-4040
Mailing Address - Country:US
Mailing Address - Phone:931-243-3860
Mailing Address - Fax:931-243-4607
Practice Address - Street 1:110 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:TN
Practice Address - Zip Code:38551-5092
Practice Address - Country:US
Practice Address - Phone:931-243-3860
Practice Address - Fax:931-243-4607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN135207Q00000X, 261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4227265OtherBLUE CROSS BLUE SHIELD
TN1356427462Medicaid
TN3873320Medicaid
TN01287940Medicaid
TN443448Medicare PIN
TN1356427462Medicaid