Humphreys County Community Health Services Inc
Organization Active NPI Rural Health Clinic/Center · Waverly, TN
NPI 1164033213 · NPPES record last updated Apr 4, 2022
Key facts
- NPI
- 1164033213
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- HUMPHREYS COUNTY COMMUNITY HEALTH SERVICES INC
- Practice address
- 451 Highway 13 S
Waverly, TN 37185-2109 - Phone
- (931) 296-0211
- Fax
- (931) 296-0199
- NPI assigned
- Aug 12, 2020
- Organization subpart
- No
Authorized official
- Name
- Shannon Allison
- Title
- Finance Manager
- Phone
- (931) 296-0111
Owners & managing parties with NPI records 2
Owned or controlled facilities with NPI records 2
Other NPIs with the same Medicare PAC ID 2
Corporate family (same tax ID) 1
Member of 1
Related certifications (CCN) 1
Facilities with the same owner 2
Practitioners 19
-
Amanda Deason, NP
-
Jennifer Dawn Davis, APRN
-
Frances Elaine Hibbs, FNP
-
Daniel Arteaga, M.D.
-
Toni Hall, D.O.
-
Laura Zabalgoitia, MD, MPH
-
Gathline Etienne, MD
-
Krishna J Goli, M.D.
-
Shivali Kanal, PA-C
-
Anna Ndashe Katema, D.O
-
Heidi T Woessner, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Rural health clinic certification: CCN 443471
- Legal name
- HUMPHREYS COUNTY COMMUNITY HEALTH SERVICES, INC.
- Doing business as
- ASCENSION SAINT THOMAS THREE RIVERS PRIMARY CARE
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Dec 15, 2020
- Last certification
- Mar 4, 2026
- Ownership / control type
- 2B
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jan 29, 2008 in TN
- Enrollment address
- 451 Highway 13 S
Waverly, TN 37185-2109 - Related CCNs
- 441303
All disclosed owners & managing parties 5
| Name | Role | Since | Share |
|---|---|---|---|
| Sienna Miller |
W-2 Managing Employee |
Feb 26, 2025 | |
| Brandon Williams |
Corporate Director |
Oct 31, 2022 | |
| Shannon Allison |
Corporate Officer |
Aug 3, 2015 | |
| W-2 Managing Employee |
Aug 3, 2015 | ||
| Freda Russell |
Corporate Officer |
May 9, 2011 | 10% |
| Corporate Director |
May 9, 2011 | 10% | |
| W-2 Managing Employee |
May 9, 2011 | 10% | |
| Operational/Managerial Control |
May 9, 2011 | 10% | |
| Humphreys County Community Health Services, Inc. |
5% Or Greater Direct Ownership Interest | Aug 1, 2008 | 100% |
All facility ownership & control disclosures 2
| Facility | Type | Role | Since |
|---|---|---|---|
| Ascension Saint Thomas Three Rivers |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Aug 1, 2008 |
| Ascension Saint Thomas Three Rivers |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Aug 1, 2008 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200910000577 | TN | Part a Provider - Rural Health Clinic | 9931276359 | Practice locations: Waverly, TN |
National Provider Directory
- Tax ID family
- Humphreys County Community Health Services Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
451 Highway 13 S
Waverly, TN 37185-2109
Mailing address
451 Highway 13 S
Waverly, TN 37185-2109
Phone (931) 296-0211
Other names
- Ascension Saint Thomas Three Rivers Primary Care
Other providers in Waverly, TN
- Home Medical Care Inc
- Tammy R. Hooper
- Amy Paulette Horton
- Humphreys County Board of Education
- Humphreys County Care and Rehabilitation
- Humphreys County Community Health Services, Inc.
- Humphreys County Community Health Services, Inc.
- Lawrence Richard Jackson Jr.
- James Developmental Center Inc.
- Christian Jones
All providers in Waverly, TN · Rural Health Clinic/Center in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 4, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.