NPIMap

Organization Active NPI

Perry County Medical Center, Inc.

  • Dental Clinic/Center
  • Linden, TN
National Provider Identifier
1134937345
Registry record updated Dec 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
PERRY COUNTY MEDICAL CENTER, INC.
Practice address
153 W Main St
Linden, TN 37096-7001
Phone
(931) 589-2104
NPI assigned
Dec 19, 2024
Last updated
Dec 19, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2024

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

Authorized official

Name
Phillip TatumNPI 1992736334
Title
Ceo
Phone
(931) 589-2104

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

153 W Main St
Linden, TN 37096-7001

Mailing address

PO Box 917
Linden, TN 37096-0917

Other names 1

  • Perry County Dental Clinic Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070303000037 TN Part B Supplier - Clinic/Group Practice 4981706330 Receives reassigned benefits from 18 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Linden, TN; Lyles, TN
O20251006000500 TN Part A Provider - Federally Qualified Health Center (FQHC) 4981706330 Practice locations: Linden, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1134937345. Details of each certification follow.

Federally qualified health center certification: CCN 441031

Legal name
PERRY COUNTY MEDICAL CENTER INC
Doing business as
PERRY COUNTY DENTAL CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 24, 2025
Last certification
Sep 24, 2025
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
153 W Main St
Ste 100
Linden, TN 37096-7001

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 3

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
44D2335037Perry County Dental Clinic153 West Main Street, Linden, TN 37096Certificate of waiverDec 4, 2027

National Provider Directory

National Provider Directory
Tax ID family
Perry County Medical4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

153 W Main St
Linden, TN 37096
Phone (931) 589-2104

153 W Main St
Ste 100
Linden, TN 37096
Phone (931) 589-2104

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Phillip B Tatum Individual Corporate OfficerCeo Sep 1, 2025
Corporate DirectorCeo Sep 1, 2025
W-2 Managing EmployeeAd; Sep 1, 2025
Judy Mathis Individual Corporate OfficerBoard Member Sep 1, 2025
Diana Richardson Individual Corporate OfficerBoard Member Sep 1, 2025
Dean Heady Individual Corporate OfficerChairman Sep 1, 2025
Margarita Austin Individual Corporate OfficerBoard Member Sep 1, 2025
Juanest Cathey Individual Corporate OfficerFinancial Officer Sep 1, 2025
Leah Conder Individual Corporate OfficerBoard Member Sep 1, 2025
Betty Barber Individual Corporate OfficerBoard Member Sep 1, 2025
Jessie R Tiller Individual Corporate OfficerVice-Chairman Sep 1, 2025
Betty Culp Individual Corporate OfficerBoard Member Sep 1, 2025
Sharon Doyle Individual Corporate OfficerSecretary Sep 1, 2025

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1734566400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734566400000",
    "number": "1134937345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 917",
            "city": "LINDEN",
            "state": "TN",
            "postal_code": "370960917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "153 W MAIN ST",
            "city": "LINDEN",
            "state": "TN",
            "postal_code": "370967001",
            "telephone_number": "931-589-2104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERRY COUNTY MEDICAL CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-19",
        "last_updated": "2024-12-19",
        "certification_date": "2024-12-19",
        "status": "A",
        "authorized_official_last_name": "TATUM",
        "authorized_official_first_name": "PHILLIP",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "931-589-2104"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Perry County Dental Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Linden, TN

Sources for this page

Verify at the official NPI Registry.