Provider Demographics
NPI:1538252010
Name:CUMBERLAND HEART CLINIC, PLLC
Entity type:Organization
Organization Name:CUMBERLAND HEART CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-484-8100
Mailing Address - Street 1:49 CLEVELAND ST.
Mailing Address - Street 2:STE. 250
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555
Mailing Address - Country:US
Mailing Address - Phone:931-484-8100
Mailing Address - Fax:931-707-9135
Practice Address - Street 1:49 CLEVELAND ST.
Practice Address - Street 2:STE. 250
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555
Practice Address - Country:US
Practice Address - Phone:931-484-8100
Practice Address - Fax:931-707-9135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00060241OtherRAILROAD MEDICARE
TNP00060241OtherRAILROAD MEDICARE