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Organization
UPPER CUMBERLAND PHYSICIANS SURGERY CENTER LLC
Active
Organization
UPPER CUMBERLAND PHYSICIANS SURGERY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTEN O'CONNOR (OFFICER/AUTHORIZED OFFICIAL)
(615) 376-7315
Entity
Organization
Contact information
Practice address
467 N WHITNEY AVE, COOKEVILLE, TN 38501-2454
(931) 528-5007
(931) 528-5030
Mailing address
14201 DALLAS PKWY, DALLAS, TX 75254-2916
(972) 763-3859
(972) 920-3445
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
0000000155
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3288863
—
TN
01
—
P00114892
RAILROAD MEDICARE
TN
Enumeration date
05/26/2006
Last updated
03/01/2021
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