Organization
UPPER CUMBERLAND ORTHOPEDIC SURGERY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAULA A EASTERLY (MANAGER)
(931) 372-7716
Entity
Organization
Contact information
Practice address
105 S. WILLOW AVE., COOKEVILLE, TN 38501
(931) 526-9518
(931) 372-0087
Mailing address
105 S. WILLOW AVE, COOKEVILLE, TN 38501
(931) 526-9518
(931) 372-0087
Taxonomy
Speciality
Code
Description
License number
State
204C00000X
Sports Medicine (Neuromusculoskeletal Medicine) Physician
—
—
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3704956
—
TN
05
—
65942575
—
KY
Enumeration date
09/27/2005
Last updated
01/02/2020
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