NPIMap

Organization Active NPI

WTPC, LLC

  • Rural Health Clinic/Center
  • Henderson, TN
National Provider Identifier
1386235083
Registry record updated Jan 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
WTPC, LLC
Practice address
541 W Park PL
Henderson, TN 38340-2027
Phone
(731) 989-1007
Fax
(731) 989-0704
NPI assigned
Jan 27, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2024

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

Authorized official

Name
Cameron S Burks
Title
Practice Adminsitrator
Phone
(731) 989-1007

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

541 W Park PL
Henderson, TN 38340-2027

Mailing address

541 W Park PL
Henderson, TN 38340-2027
Phone (731) 989-1007

Other identifiers 1

IdentifierTypeStateIssuer
883844OtherTNPTAN

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20210205001703 TN Part B Supplier - Clinic/Group Practice 2668886409 Receives reassigned benefits from 5 practitioners
Practice locations: Henderson, TN
O20210311000179 TN Part A Provider - Rural Health Clinic 2668886409 Practice locations: Henderson, TN

Rural health clinic certification: CCN 883844

Legal name
WTPC, LLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 4, 2021
Last certification
Apr 1, 2026
Ownership / control type
1C
Organization structure
LLCProprietary
Incorporated
Jan 27, 2021 in TN
Enrollment address
541 W Park PL
Henderson, TN 38340-2027

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
44D2218804WTPC, LLC541 W Park PL, Henderson, TN 38340Provider-performed microscopyMar 30, 2027

National Provider Directory

National Provider Directory

Locations

541 W Park Pl
Henderson, TN 38340
Phone (731) 506-4242

557 W Park Pl
Henderson, TN 38340
Phone (731) 989-1007

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
Cameron Burks Individual 5% Or Greater Direct Ownership InterestPractice Administrator Jan 27, 2021 50%
W-2 Managing EmployeeAd; Jan 27, 2021
Traci K Hill Individual 5% Or Greater Direct Ownership InterestNurse Practitioner Jan 27, 2021 50%

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1611705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704326400000",
    "number": "1386235083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "541 W PARK PL",
            "city": "HENDERSON",
            "state": "TN",
            "postal_code": "383402027",
            "telephone_number": "731-989-1007",
            "fax_number": "731-989-0704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "541 W PARK PL",
            "city": "HENDERSON",
            "state": "TN",
            "postal_code": "383402027",
            "telephone_number": "731-989-1007",
            "fax_number": "731-989-0704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WTPC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-27",
        "last_updated": "2024-01-04",
        "certification_date": "2024-01-04",
        "status": "A",
        "authorized_official_last_name": "BURKS",
        "authorized_official_first_name": "CAMERON",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRACTICE ADMINSITRATOR",
        "authorized_official_telephone_number": "731-989-1007"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "883844",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Henderson, TN

Sources for this page

Verify at the official NPI Registry.