NPIMap

Organization Active NPI

State of Tennessee

  • Public Health or Welfare Agency
  • Dover, TN
National Provider Identifier
1083767883
Registry record updated Aug 28, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Public Health or Welfare AgencyTaxonomy code 251K00000X
Legal business name
STATE OF TENNESSEE
Practice address
1021 Spring St
Dover, TN 37058-3302
Phone
(931) 232-5329
Fax
(931) 232-7247
NPI assigned
Jan 18, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2012

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

Authorized official

Name
Mr. Annette M. Haley
Title
Regional Director
Phone
(615) 650-7000

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health or Welfare Agency 251K00000X TN Primary
Federally Qualified Health Center (FQHC) 261QF0400X TN

Addresses

Primary practice location

1021 Spring St
Dover, TN 37058-3302

Mailing address

1021 Spring St
Dover, TN 37058-3302
Phone (931) 232-5329

Other identifiers 1

IdentifierTypeStateIssuer
4448019MedicaidTN

Other names 1

  • Stewart County Community Medical Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040402001142 TN Part A Provider - Federally Qualified Health Center (FQHC) 5698687077 Practice locations: Dover, TN

Federally qualified health center certification: CCN 441848

Legal name
STATE OF TENNESSEE
Doing business as
STEWART COUNTY COMMUNITY MEDICAL CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 20, 1992
Last certification
Jan 20, 1992
Ownership / control type
Non-profit – corporation
Organization structure
OtherNon-profit
Enrollment address
1021 Spring St
Dover, TN 37058-3302

National Provider Directory

National Provider Directory
Tax ID family
Trousdale County Health202 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

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

View all 24

Locations

301 W End Ave
Dickson, TN 37055
Phone (615) 446-2839

541 E Main St
Hartsville, TN 37074
Phone (615) 374-2112

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Sanjana Stamm Individual Corporate Director May 1, 2017 25%
Operational/Managerial ControlRegional Director May 1, 2017 25%
Karen Anderson Individual Operational/Managerial ControlCounty Director Feb 1, 2014 75%
State of Tennessee Organization, Dover, TN Operational/Managerial Control Feb 19, 1987 100%

All facility ownership & control disclosures 17

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Middle Tennessee Mental Health InstituteNashville, TN, CCN 444014 Hospital 5% Or Greater Direct Ownership Interest (100%) Nov 1, 1995
Moccasin Bend Mental Health InstituteChattanooga, TN, CCN 444002 Hospital Operational/Managerial Control (100%) Jul 1, 2008
Overton County Health DepartmentLivingston, TN, CCN 441840 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Other (100%)		 Apr 23, 2014
Apr 23, 2014
Cannon County Health DepartmentWoodbury, TN, CCN 441828 Federally qualified health center Other Apr 23, 2014
Clay County Health DepartmentCelina, TN, CCN 441831 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Other (100%)		 Apr 23, 2014
Apr 23, 2014
Cumberland County Health DepartmentCrossville, TN, CCN 441832 Federally qualified health center Other Apr 23, 2014
Dekalb County Health DepartmentSmithville, TN, CCN 441834 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Other (100%)		 Apr 23, 2014
Apr 23, 2014
Fentress County Health DepartmentJamestown, TN, CCN 441835 Federally qualified health center Other Apr 23, 2014
Jackson County Health DepartmentGainesboro, TN, CCN 441837 Federally qualified health center Other Apr 23, 2014
Macon County Health DepartmentLafayette, TN, CCN 441838 Federally qualified health center Other Apr 23, 2014
Pickett County Health DepartmentByrdstown, TN, CCN 441841 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Other (100%)		 Apr 23, 2014
Apr 23, 2014
Putnam County Health DepartmentCookeville, TN, CCN 441842 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Other (100%)		 Apr 23, 2014
Apr 23, 2014
Smith County Health DepartmentCarthage, TN, CCN 441843 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Other (100%)		 Apr 23, 2014
Apr 23, 2014
Van Buren County Health DepartmentSpencer, TN, CCN 441844 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Other (100%)		 Apr 23, 2014
Apr 23, 2014
Warren County Health DepartmentMcMinnville, TN, CCN 441845 Federally qualified health center Other Apr 23, 2014
White County Health DepartmentSparta, TN, CCN 441847 Federally qualified health center Other Apr 23, 2014
Gibson County Health Department/Community Health CenterTrenton, TN, CCN 441968 Federally qualified health center Operational/Managerial Control (100%) Aug 1, 2015

Facilities with the same owner 10

Facilities that share an organizational owner with 5% or greater ownership or operational control.

NPI Registry JSON

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1346112000000",
    "number": "1083767883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1021 SPRING ST",
            "city": "DOVER",
            "state": "TN",
            "postal_code": "370583302",
            "telephone_number": "931-232-5329",
            "fax_number": "931-232-7247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1021 SPRING ST",
            "city": "DOVER",
            "state": "TN",
            "postal_code": "370583302",
            "telephone_number": "931-232-5329",
            "fax_number": "931-232-7247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF TENNESSEE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-18",
        "last_updated": "2012-08-28",
        "status": "A",
        "authorized_official_last_name": "HALEY",
        "authorized_official_first_name": "ANNETTE",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "REGIONAL DIRECTOR",
        "authorized_official_telephone_number": "615-650-7000",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": "TN",
            "license": null,
            "primary": true
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "TN",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4448019",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stewart County Community Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dover, TN

Sources for this page

Verify at the official NPI Registry.