Organization
COOKEVILLE REGIONAL MEDICAL GROUP, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARILYN C KEY (CEO)
(931) 783-2481
Entity
Organization
Contact information
Practice address
140 W 7TH ST, COOKEVILLE, TN 38501-1726
(931) 783-5582
Mailing address
PO BOX 15060, BELFAST, ME 04915-4045
(931) 783-5857
(931) 526-6760
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
TN
363AS0400X
Surgical Physician Assistant
—
TN
363L00000X
Nurse Practitioner
—
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3727506
MEDICARE GROUP PTAN
—
Enumeration date
07/07/2006
Last updated
06/21/2023
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