Rural Health Services Consortium of Upper East Tennessee Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Rogersville, TN
NPI 1346672995 · NPPES record last updated May 18, 2023
Key facts
- NPI
- 1346672995
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- RURAL HEALTH SERVICES CONSORTIUM OF UPPER EAST TENNESSEE INC
- Practice address
- 4307 Highway 66 S
Rogersville, TN 37857-3155 - Phone
- (423) 921-1600
- Fax
- (423) 921-1677
- NPI assigned
- Aug 6, 2013
- Organization subpart
- No
Authorized official
- Name
- Mrs. Linda W Buck
- Title
- President/Ceo
- Phone
- (423) 272-9163
Owners & managing parties with NPI records 12
Other NPIs with the same Medicare PAC ID 12
Corporate family (same tax ID) 5
Practitioners 50
-
Brandy Reshea Ball, FNP
-
Emily Faye Benfield, FNP
-
Mica Lauren Brown, FNP
-
Samuel Brown, FNP
-
Amanda Dawn Cornett, FNP
-
Nancy Anne Crider, LPC
-
Mark Joseph Dalle-Ave, M.D.
-
Mark R Doman, M.D.
-
Kristen Dykes, FNP
-
Leslie Renee Elliott, FNP-BC
-
Ann Elizabeth Espey, APN
-
Phyllis C Fisher, FNP
-
Rachiel Erin Gibson, PA-C
-
Jamesia Hicks Harris, NP-C
-
Duskin Henard, DPT
-
Amy Romeo Herron, LCSW
-
Michael E Hill, NP-C
-
Kelly Jane Hopkins, FNP
-
Jennifer E. Lane, N.P.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Federally qualified health center certification: CCN 441960
- Legal name
- RURAL HEALTH SERVICES CONSORTIUM OF UPPER EAST TENNESSEE INC
- Doing business as
- ROGERSVILLE MEDICAL COMPLEX
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Dec 11, 2013
- Last certification
- Dec 11, 2013
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jun 21, 1985 in TN
- Enrollment address
- 4307 Highway 66 S
Rogersville, TN 37857-3155
All disclosed owners & managing parties 15
| Name | Role | Since | Share |
|---|---|---|---|
| Linda W. Buck |
Corporate Officer | Jul 29, 2002 | |
| W-2 Managing Employee | Jul 29, 2002 | ||
| Amelia E Bailey |
Corporate Director |
Mar 25, 2021 | |
| Silvia Fregoso |
Corporate Director | Jul 24, 2006 | |
| Rural Health Services Consortium of Upper East Tennessee Inc |
Operational/Managerial Control | Dec 30, 2013 | |
| Cloyce Eller |
Corporate Director | Mar 27, 1999 | |
| Geren Michael Street |
Corporate Director |
Jul 23, 2020 | |
| Minnie Miller |
Corporate Director | Apr 1, 2012 | |
| Terry Cunningham |
Corporate Director | Jul 16, 2002 | |
| Jacqueline Charles |
Corporate Director | Sep 23, 2004 | |
| Charles R Huffman |
Corporate Director |
Oct 24, 2019 | |
| Joseph Paul Frye |
Corporate Director | Sep 23, 2004 | |
| Timothy R Smithson |
Corporate Director |
Apr 1, 2019 | |
| Betty Greene |
Corporate Director | Jul 24, 2006 | |
| Charles Herman Heck |
Corporate Director |
Sep 22, 2016 | |
| Lorena Reynoso |
Corporate Director |
Jul 25, 2019 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20131210000296 | TN | Part a Provider - Federally Qualified Health Center (FQHC) | 0941118111 | Practice locations: Rogersville, TN |
National Provider Directory
- Tax ID family
- Rural Health S Ervices Co
Locations
4307 Highway 66 S
Rogersville, TN 37857
Phone (423) 921-1600
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
4307 Highway 66 S
Rogersville, TN 37857-3155
Mailing address
PO Box 850
Rogersville, TN 37857-0850
Phone (423) 272-9163
Other names
- Rogersville Medical Complex
Other providers in Rogersville, TN
- Rogersville Professional Pharmacy LLC
- Rogersville Vision Clinic,PLLC
- Rural Health Services Consortium
- Rural Health Services Consortium of Upper East Tennessee Inc
- Rural Health Services Consortium of Upper East Tennessee Inc
- Rural Health Services Consortium of Upper East Tennessee Inc
- Rural Health Services Consortium of Upper East Tennessee Inc
- Cathy L Sandidge
- David Charles Saunders
- Horace Edward Saunders III
All providers in Rogersville, TN · Federally Qualified Health Center (FQHC) in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 18, 2023. 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.