Organization
UPPER CUMBERLAND ANESTHESIA ASSOCIATES, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT HARRISON LANDRY MD (PRESIDENT)
(931) 528-7877
Entity
Organization
Contact information
Practice address
1 MEDICAL CENTER BLVD, COOKEVILLE, TN 38501-4294
(931) 528-5587
Mailing address
PO BOX 280, COOKEVILLE, TN 38503-0280
(931) 528-7877
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
65945206
—
KY
05
—
74904152
—
KY
01
—
CD2499
MEDICARE RAILROAD
—
Enumeration date
07/07/2006
Last updated
04/14/2020
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