Provider Demographics
NPI:1780805010
Name:CUMBERLAND PLATEAU SURGICAL ASSOCIATES
Entity type:Organization
Organization Name:CUMBERLAND PLATEAU SURGICAL ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:W
Authorized Official - Last Name:PATE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-738-9003
Mailing Address - Street 1:621 N SPRING ST
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:TN
Mailing Address - Zip Code:38583-1159
Mailing Address - Country:US
Mailing Address - Phone:931-738-9003
Mailing Address - Fax:931-738-9085
Practice Address - Street 1:621 N SPRING ST
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:TN
Practice Address - Zip Code:38583-1159
Practice Address - Country:US
Practice Address - Phone:931-738-9003
Practice Address - Fax:931-738-9085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3099498Medicare ID - Type Unspecified