NPIMap

Organization Active NPI

Tanner Medical Clinic LLC

  • Rural Health Clinic/Center
  • Tanner, AL
National Provider Identifier
1376881870
Registry record updated May 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
TANNER MEDICAL CLINIC LLC
Practice address
20104 Swanner Blvd
Suite 4
Tanner, AL 35671-3651
Phone
(256) 686-3334
Fax
(256) 686-3339
NPI assigned
Jan 18, 2013
Last updated
May 23, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 23, 2023

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

Authorized official

Name
Michelle Sloan Graham, FNP-CNPI 1255894994
Title
VP of Operations
Phone
(256) 432-2822

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X
Rural Health Clinic/Center 261QR1300X AL Primary
Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

20104 Swanner Blvd
Suite 4
Tanner, AL 35671-3651

Mailing address

20104 Swanner Blvd
Tanner, AL 35671-3651
Phone (256) 686-3334

Other identifiers 1

IdentifierTypeStateIssuer
159174MedicaidAL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20130515000221 AL Part B Supplier - Clinic/Group Practice 8921245796 Receives reassigned benefits from 5 practitioners
Practice locations: Tanner, AL
O20131025000753 AL Part A Provider - Rural Health Clinic 8921245796 Practice locations: Tanner, AL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1376881870. Details of each certification follow.

Rural health clinic certification: CCN 018908

Legal name
TANNER MEDICAL CLINIC LLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 27, 2014
Last certification
Feb 26, 2026
Ownership / control type
1B
Organization structure
LLCProprietary
Enrollment address
20104 Swanner Blvd
Tanner, AL 35671-3651

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
01D2054757Tanner Medical Clinic LLC20104 Swanner Blvd Suite 4, Tanner, AL 35671Certificate of waiverFeb 26, 2027

National Provider Directory

National Provider Directory

Locations

20104 Swanner Blvd
Tanner, AL 35671
Phone (256) 686-3334

20104 Swanner Blvd
#4
Tanner, AL 35671
Phone (256) 686-3334

20104 Swanner Blvd
Ste 4
Tanner, AL 35671
Phone (256) 686-3334

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/17003/brand/1/csg/1/fhir/r4

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Kim L Harbin Individual 5% Or Greater Direct Ownership InterestOwner Jul 17, 2019 100%
Michelle Sloan Graham Individual Operational/Managerial ControlVice President of Operations Jul 17, 2019 100%

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 7

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": "1358467200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684800000000",
    "number": "1376881870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20104 SWANNER BLVD",
            "city": "TANNER",
            "state": "AL",
            "postal_code": "356713651",
            "telephone_number": "256-686-3334",
            "fax_number": "256-686-3339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20104 SWANNER BLVD",
            "address_2": "SUITE 4",
            "city": "TANNER",
            "state": "AL",
            "postal_code": "356713651",
            "telephone_number": "256-686-3334",
            "fax_number": "256-686-3339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TANNER MEDICAL CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-18",
        "last_updated": "2023-05-23",
        "certification_date": "2023-05-23",
        "status": "A",
        "authorized_official_last_name": "GRAHAM",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "SLOAN",
        "authorized_official_title_or_position": "VP OF OPERATIONS",
        "authorized_official_telephone_number": "256-432-2822",
        "authorized_official_credential": "FNP-C"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "AL",
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "159174",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tanner, AL

Sources for this page

Verify at the official NPI Registry.