| Cumberland Family Care Pc | |
|
457 Vista Dr Sparta TN 38583-1360 | |
| (931) 738-3383 | |
| (931) 738-8911 |
| Full Name | Cumberland Family Care Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 457 Vista Dr, Sparta, Tennessee |
| Authorized Official Name and Position | Mischelle Lynn Ferrell (PRACTICE ADMINISTRATOR) |
| Authorized Official Contact | 9317383383 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cumberland Family Care Pc 457 Vista Dr Sparta TN 38583-1360 Ph: (931) 738-3383 | Cumberland Family Care Pc 457 Vista Dr Sparta TN 38583-1360 Ph: (931) 738-3383 |
| NPI Number | 1225003809 |
|---|---|
| Provider Enumeration Date | 02/17/2006 |
| Last Update Date | 07/01/2016 |
| Medicare PECOS PAC ID | 8729041835 |
|---|---|
| Medicare Enrollment ID | O20041110000115 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225003809 | NPI | - | NPPES |
| 3713471 | Medicaid | TN | |
| CI1932 | Other | TN | RAILROAD MEDICARE PIN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Ty T Webb |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1174512974 PECOS PAC ID: 4880657907 Enrollment ID: I20100419000188 |
| Provider Name | Marla J Moore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740279397 PECOS PAC ID: 8325177066 Enrollment ID: I20100519000058 |
| Provider Name | Johnna M Sprague |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194190306 PECOS PAC ID: 1759686819 Enrollment ID: I20160226001523 |
| Provider Name | James Clark Childress |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316509334 PECOS PAC ID: 6901133784 Enrollment ID: I20190816001981 |
| Provider Name | Kimberly N Parrish |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497344014 PECOS PAC ID: 6103212345 Enrollment ID: I20220415000111 |
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