# COOKEVILLE MEDICAL CENTER PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Cookeville Medical Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013055912
- **Authorized official:** DR. PUSHPENDRA K JAIN M.D. (CEO)
- **Authorized official phone:** (931) 528-8899

## Contact information

- **Practice address:** 225 N WILLOW AVE, COOKEVILLE, TN 38501-2335
- **Practice address phone:** (931) 528-8899
- **Practice address fax:** (866) 813-8531
- **Mailing address:** 225 N WILLOW AVE, COOKEVILLE, TN 38501-2335
- **Mailing address phone:** (931) 528-8899
- **Mailing address fax:** (866) 813-8531

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 261QR0200X | Radiology Clinic/Center | — | NULL | — |
| 291U00000X | Clinical Medical Laboratory | — | NULL | — |

## Other

- **Enumeration date:** 02/02/2007
- **Last updated:** 06/18/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 3709492 | — | TN |