NPIMap

Organization Active NPI

Hardin County Regional Health Center

Doing business as Lifespan Health

  • Federally Qualified Health Center (FQHC)
  • Clifton, TN
National Provider Identifier
1063660595
Registry record updated Jan 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
HARDIN COUNTY REGIONAL HEALTH CENTER
Doing business as
Lifespan Health
Practice address
207 Main St
Clifton, TN 38425-5547
Phone
(931) 676-3245
NPI assigned
Sep 9, 2008
Last updated
Jan 27, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2021

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

Authorized official

Name
Yainieh T. McGinley
Title
Ceo
Phone
(731) 925-2300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

207 Main St
Clifton, TN 38425-5547

Mailing address

PO Box 655
Savannah, TN 38372-0655
Phone (731) 925-2300

Other identifiers 1

IdentifierTypeStateIssuer
0441906MedicaidTN

Other names 1

  • Lifespan Health Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060801000280 TN Part A Provider - Federally Qualified Health Center (FQHC) 3779490776 1 other NPI on this enrollment
Practice locations: Clifton, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1063660595. Details of each certification follow.

Federally qualified health center certification: CCN 441906

Legal name
HARDIN COUNTY REGIONAL HEALTH CENTER
Doing business as
LIFESPAN HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 21, 2006
Last certification
Sep 21, 2006
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 13, 1993 in TN
Enrollment address
207 Main Street
Clifton, TN 38425-5547

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Hardin County Regional Health Center5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 14

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
James Baker Individual Corporate DirectorBoard Member Jan 22, 2015
Vincent Hopson Individual Corporate Director Jul 5, 2006
Ryan Miller Individual Corporate DirectorBoard Member Dec 13, 2018
Jennifer Lynn Williams Individual Corporate OfficerCfo Apr 21, 2008
Matthew McGinley Individual W-2 Managing Employee Jul 5, 2006
Rita Maxedon Individual Corporate Director Jul 5, 2006
Stephen Milligan Individual Corporate DirectorBoard Member Jan 1, 2012
June Lafran Plunk Individual Corporate DirectorBorad Member Jul 31, 2022
Charles Bevis Individual Corporate Director Jul 5, 2006
Allen Cherry Individual Corporate Director Jul 5, 2006
Tony Polk Individual Corporate Director Jul 22, 2010
Cora Damron Individual Corporate Director Jul 5, 2006
Mina Bhakta Individual Corporate DirectorBoard Member Dec 13, 2018
Rebecca L Wright Individual Corporate OfficerCeo Oct 22, 2024
W-2 Managing EmployeeCeo Oct 22, 2024

NPI Registry JSON

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

{
    "created_epoch": "1220918400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611705600000",
    "number": "1063660595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 655",
            "city": "SAVANNAH",
            "state": "TN",
            "postal_code": "383720655",
            "telephone_number": "731-925-2300",
            "fax_number": "731-925-2157"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 MAIN ST",
            "city": "CLIFTON",
            "state": "TN",
            "postal_code": "384255547",
            "telephone_number": "931-676-3245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HARDIN COUNTY REGIONAL HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-09",
        "last_updated": "2021-01-27",
        "certification_date": "2021-01-27",
        "status": "A",
        "authorized_official_last_name": "MCGINLEY",
        "authorized_official_first_name": "YAINIEH",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "731-925-2300"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0441906",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lifespan Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clifton, TN

Sources for this page

Verify at the official NPI Registry.