Provider Demographics
NPI:1871791335
Name:CUMBERLAND BACK PAIN CLINIC
Entity type:Organization
Organization Name:CUMBERLAND BACK PAIN CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:DREIFKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-591-2754
Mailing Address - Street 1:120 CHADWICK SQUARE CT STE A
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28739-3200
Mailing Address - Country:US
Mailing Address - Phone:615-591-2754
Mailing Address - Fax:615-591-2755
Practice Address - Street 1:120 CHADWICK SQUARE CT STE A
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28739-3200
Practice Address - Country:US
Practice Address - Phone:615-591-2754
Practice Address - Fax:615-591-2755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty