NPIMap

Organization Active NPI

Rural Health Services Consortium of Upper East Tennessee Inc

  • Federally Qualified Health Center (FQHC)
  • Rogersville, TN
National Provider Identifier
1346672995
Registry record updated May 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 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
Last updated
May 18, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 18, 2023

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

Authorized official

Name
Mrs. Linda W Buck
Title
President/Ceo
Phone
(423) 272-9163

Specialties & licenses 1

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

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 1

  • Rogersville Medical Complex Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20131210000296 TN Part A Provider - Federally Qualified Health Center (FQHC) 0941118111 Practice locations: Rogersville, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1346672995. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Jun 21, 1985 in TN
Enrollment address
4307 Highway 66 S
Rogersville, TN 37857-3155

Other NPIs with the same Medicare PAC ID 12

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

National Provider Directory

National Provider Directory
Tax ID family
Rural Health Services Con6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Locations

4307 Highway 66 S
Rogersville, TN 37857
Phone (423) 921-1600

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Linda W. Buck Individual Corporate Officer Jul 29, 2002
W-2 Managing Employee Jul 29, 2002
Amelia E Bailey Individual Corporate DirectorBoard Member Mar 25, 2021
Silvia Fregoso Individual Corporate Director Jul 24, 2006
Rural Health Services Consortium of Upper East Tennessee Inc Organization, Rogersville, TN Non-profit Operational/Managerial Control Dec 30, 2013
Cloyce Eller Individual Corporate Director Mar 27, 1999
Geren Michael Street Individual Corporate DirectorBoard Member Jul 23, 2020
Minnie Miller Individual Corporate Director Apr 1, 2012
Terry Cunningham Individual Corporate Director Jul 16, 2002
Jacqueline Charles Individual Corporate Director Sep 23, 2004
Charles R Huffman Individual Corporate DirectorBoard Member Oct 24, 2019
Joseph Paul Frye Individual Corporate Director Sep 23, 2004
Timothy R Smithson Individual Corporate DirectorBoard Member Apr 1, 2019
Betty Greene Individual Corporate Director Jul 24, 2006
Charles Herman Heck Individual Corporate DirectorBoard Member Sep 22, 2016
Lorena Reynoso Individual Corporate DirectorBoard Member Jul 25, 2019

Owners & managing parties with NPI records 12

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

NPI Registry JSON

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

{
    "created_epoch": "1375747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684368000000",
    "number": "1346672995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 850",
            "city": "ROGERSVILLE",
            "state": "TN",
            "postal_code": "378570850",
            "telephone_number": "423-272-9163",
            "fax_number": "423-921-6920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4307 HIGHWAY 66 S",
            "city": "ROGERSVILLE",
            "state": "TN",
            "postal_code": "378573155",
            "telephone_number": "423-921-1600",
            "fax_number": "423-921-1677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RURAL HEALTH SERVICES CONSORTIUM OF UPPER EAST TENNESSEE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-06",
        "last_updated": "2023-05-18",
        "certification_date": "2023-05-18",
        "status": "A",
        "authorized_official_last_name": "BUCK",
        "authorized_official_first_name": "LINDA",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "423-272-9163",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rogersville Medical Complex",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Rogersville Medical Complex",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Rogersville, TN

Sources for this page

Verify at the official NPI Registry.