NPIMap

Organization Active NPI

Hardeman County Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Henderson, TN
National Provider Identifier
1366637969
Registry record updated Apr 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
HARDEMAN COUNTY COMMUNITY HEALTH CENTER
Practice address
1132 Industrial Dr
Henderson, TN 38340-1310
Phone
(731) 983-3175
Fax
(731) 983-3356
NPI assigned
Sep 7, 2007
Last updated
Apr 23, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
HARDEMAN COUNTY COMMUNITY HEALTH CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 23, 2025

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

Authorized official

Name
Linda Lovelace
Title
Coo/Cfo
Phone
(731) 659-3125

Specialties & licenses 1

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

Addresses

Primary practice location

1132 Industrial Dr
Henderson, TN 38340-1310

Mailing address

PO Box 720
Bolivar, TN 38008-0720

Other identifiers 1

IdentifierTypeStateIssuer
0441916MedicaidTN

Other names 1

  • Henderson Health Center Other name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040615001290 TN Part B Supplier - Clinic/Group Practice 5799694147 Receives reassigned benefits from 14 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bolivar, TN; Stanton, TN; Henderson, TN
O20070919000416 TN Part A Provider - Federally Qualified Health Center (FQHC) 5799694147 Practice locations: Henderson, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1366637969. Details of each certification follow.

Federally qualified health center certification: CCN 441916

Legal name
HARDEMAN COUNTY COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 1, 2007
Last certification
Dec 1, 2007
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 1, 1992 in TN
Enrollment address
1132 Industrial Dr
Henderson, TN 38340-1310

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 4

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
44D1077005Henderson Health Center1132 Industrial Dr, Henderson, TN 38340Provider-performed microscopyNov 28, 2027

National Provider Directory

National Provider Directory
Tax ID family
Hardeman County Community6 organizations share this tax ID, including this one
Part of
Hardeman County Community

Other organizations with this tax ID 5

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

Locations

1132 Industrial Dr
Henderson, TN 38340
Phone (731) 983-3175

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Marlita White Individual Corporate OfficerChief Executive Director Jan 14, 2019
W-2 Managing EmployeeChief Executive Director Jan 14, 2019
Linda D Lovelace Individual Corporate OfficerChief Financial Officer Sep 10, 2007
W-2 Managing EmployeeChief Financial Officer Dec 2, 2002
Delphus Hicks Individual Corporate Director Dec 2, 2002
Donna Pinner Individual Corporate DirectorSecretary of Board of Directors Aug 1, 2013
Darrell R Teubner Individual Corporate Director Dec 2, 2002
Barbara Hudson Individual Corporate DirectorChair of Board of Director Nov 1, 2011
Ocie Holmes Individual Corporate Director Sep 1, 2017
Erma Williams Individual Corporate DirectorTreasurer of Board of Directors Dec 2, 2002
Linda Jones Individual Corporate Director Dec 1, 2012

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1189123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745366400000",
    "number": "1366637969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 720",
            "city": "BOLIVAR",
            "state": "TN",
            "postal_code": "380080720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1132 INDUSTRIAL DR",
            "city": "HENDERSON",
            "state": "TN",
            "postal_code": "383401310",
            "telephone_number": "731-983-3175",
            "fax_number": "731-983-3356"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HARDEMAN COUNTY COMMUNITY HEALTH CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HARDEMAN COUNTY COMMUNITY HEALTH CENTER",
        "enumeration_date": "2007-09-07",
        "last_updated": "2025-04-23",
        "certification_date": "2025-04-23",
        "status": "A",
        "authorized_official_last_name": "LOVELACE",
        "authorized_official_first_name": "LINDA",
        "authorized_official_title_or_position": "COO/CFO",
        "authorized_official_telephone_number": "731-659-3125"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0441916",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Henderson Health Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Henderson, TN

Sources for this page

Verify at the official NPI Registry.