Organization
UPPER CUMBERLAND OTOLARYNGOLOGY CLINIC, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CINDY D SMITH (BUSINESS MANAGER)
(931) 520-5832
Entity
Organization
Contact information
Practice address
100 W 4TH ST, SUITE 200, COOKEVILLE, TN 38501-2448
(931) 528-1575
(931) 526-2962
Mailing address
100 W 4TH ST, SUITE 200, COOKEVILLE, TN 38501-2448
(931) 528-1575
(931) 526-2962
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2005687
BCBS
TN
05
—
3378945
—
TN
Enumeration date
12/28/2006
Last updated
08/22/2020
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