Provider Demographics
NPI:1306110002
Name:SOUTH CUMBERLAND FAMILY CARE P.L.L.C.
Entity type:Organization
Organization Name:SOUTH CUMBERLAND FAMILY CARE P.L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:HUFFMAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MSN, FNP-BC
Authorized Official - Phone:931-924-6222
Mailing Address - Street 1:215 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:MONTEAGLE
Mailing Address - State:TN
Mailing Address - Zip Code:37356-7005
Mailing Address - Country:US
Mailing Address - Phone:931-924-6222
Mailing Address - Fax:949-862-4433
Practice Address - Street 1:215 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:MONTEAGLE
Practice Address - State:TN
Practice Address - Zip Code:37356-7005
Practice Address - Country:US
Practice Address - Phone:931-924-6222
Practice Address - Fax:949-862-4433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-28
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000015897261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care