Provider Demographics
NPI:1912984196
Name:MEDICAL SPECIALISTS OF COOKEVILLE, PLLC
Entity type:Organization
Organization Name:MEDICAL SPECIALISTS OF COOKEVILLE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:M
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-528-7662
Mailing Address - Street 1:128 N WHITNEY AVE
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-2450
Mailing Address - Country:US
Mailing Address - Phone:931-528-7662
Mailing Address - Fax:931-528-1266
Practice Address - Street 1:128 N WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2450
Practice Address - Country:US
Practice Address - Phone:931-528-7662
Practice Address - Fax:931-528-1266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN020230207R00000X
TN33892207R00000X
TN38941207R00000X
TN6496207RG0100X
TN13543207RG0100X
TN7522207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Not Answered207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3723270Medicaid
TN3723270Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER