Provider Demographics
NPI:1184754111
Name:CUMBERLAND FAMILY CARE P.C.
Entity type:Organization
Organization Name:CUMBERLAND FAMILY CARE P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MISCHELLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:FERRELL
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:931-738-3383
Mailing Address - Street 1:457 VISTA DR
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:TN
Mailing Address - Zip Code:38583-1360
Mailing Address - Country:US
Mailing Address - Phone:931-738-3383
Mailing Address - Fax:931-738-8911
Practice Address - Street 1:817 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:TN
Practice Address - Zip Code:38585-3436
Practice Address - Country:US
Practice Address - Phone:931-946-2113
Practice Address - Fax:931-946-2248
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CUMBERLAND FAMILY CARE, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-07
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN44-3957OtherRURAL HEALTH CLINIC DESIGNATION
TN44-3957OtherRURAL HEALTH CLINIC DESIGNATION