NPIMap

Organization Active NPI

Frontier Health

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Rogersville, TN
National Provider Identifier
1043374564
Registry record updated Oct 5, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
L 214-076-1416 Issued in TN
Legal business name
FRONTIER HEALTH
Practice address
101 Lena Dr
Rogersville, TN 37857-2951
Phone
(423) 272-9239
Fax
(423) 272-1803
NPI assigned
Dec 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Teresa M Kidd, PHD
Title
President and Ceo
Phone
(423) 467-3600

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X L 214-076-1416 TN
Community/Behavioral Health Agency 251S00000X L 214-076-1416 TN
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X L 214-076-1416 TN Primary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X 370 TN

Addresses

Primary practice location

101 Lena Dr
Rogersville, TN 37857-2951

Mailing address

PO Box 9054
Gray, TN 37615-9054
Phone (423) 467-3600

Other identifiers 2

IdentifierTypeStateIssuer
49-4762-2MedicaidVA
SAME AS MEDICARE #SMedicaidTN

Other names 1

  • Hawkins County Mental Health Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040109000560 TN Part B Supplier - Clinic/Group Practice 2860302320 Receives reassigned benefits from 124 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bristol, TN; Sneedville, TN; Rogersville, TN; Mountain City, TN; Kingsport, TN; Johnson City, TN; Greeneville, TN; Gray, TN…

Other NPIs on the same Medicare enrollment 14

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 14

National Provider Directory

National Provider Directory
Tax ID family
Lee County Integrated Care62 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 13

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1538697600000",
    "number": "1043374564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9054",
            "city": "GRAY",
            "state": "TN",
            "postal_code": "376159054",
            "telephone_number": "423-467-3600",
            "fax_number": "423-467-3644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 LENA DR",
            "city": "ROGERSVILLE",
            "state": "TN",
            "postal_code": "378572951",
            "telephone_number": "423-272-9239",
            "fax_number": "423-272-1803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRONTIER HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-20",
        "last_updated": "2018-10-05",
        "status": "A",
        "authorized_official_last_name": "KIDD",
        "authorized_official_first_name": "TERESA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "423-467-3600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "TN",
            "license": "L 214-076-1416",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "TN",
            "license": "L 214-076-1416",
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "TN",
            "license": "L 214-076-1416",
            "primary": true
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "TN",
            "license": "370",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "49-4762-2",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SAME AS MEDICARE #S",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hawkins County Mental Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Hawkins County Mental Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rogersville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.