State of Tennessee
Organization Active NPI Federally Qualified Health Center (FQHC) · MC Minnville, TN
NPI 1437201837 · NPPES record last updated Jan 7, 2025
Key facts
- NPI
- 1437201837
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- STATE OF TENNESSEE
- Practice address
- 1401 Sparta St
MC Minnville, TN 37110-1301 - Phone
- (931) 473-8468
- Fax
- (931) 473-0595
- NPI assigned
- Jan 17, 2007
- Organization subpart
- No
Authorized official
- Name
- Tammy Stewart
- Title
- Cfo
- Phone
- (931) 520-4203
Corporate family (same tax ID) 24
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TN
Federally qualified health center certification: CCN 441845
- Legal name
- STATE OF TENNESSEE
- Doing business as
- WARREN COUNTY HEALTH DEPARTMENT
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Oct 1, 1991
- Last certification
- Oct 1, 1991
- Ownership / control type
- Non-profit – corporation
- Organization structure
- Other · Non-profit
- Enrollment address
- 1401 Sparta St
McMinnville, TN 37110-1301
All disclosed owners & managing parties 3
| Name | Role | Since | Share |
|---|---|---|---|
| State of Tennessee |
Other | Apr 23, 2014 | |
| Tammy Stewart |
W-2 Managing Employee |
Jun 21, 2017 | |
| Deborah K Johnson |
W-2 Managing Employee |
Apr 30, 2014 |
All facility ownership & control disclosures 17
| Facility | Type | Role | Since |
|---|---|---|---|
| Middle Tennessee Mental Health Institute |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Nov 1, 1995 |
| Moccasin Bend Mental Health Institute |
Hospital | Operational/Managerial Control (100%) | Jul 1, 2008 |
| Stewart County Community Medical Center |
Federally qualified health center | Operational/Managerial Control (100%) | Feb 19, 1987 |
| Overton County Health Department |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) Other (100%) |
Apr 23, 2014 Apr 23, 2014 |
| Cannon County Health Department |
Federally qualified health center | Other | Apr 23, 2014 |
| Clay County Health Department |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) Other (100%) |
Apr 23, 2014 Apr 23, 2014 |
| Cumberland County Health Department |
Federally qualified health center | Other | Apr 23, 2014 |
| Dekalb County Health Department |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) Other (100%) |
Apr 23, 2014 Apr 23, 2014 |
| Fentress County Health Department |
Federally qualified health center | Other | Apr 23, 2014 |
| Jackson County Health Department |
Federally qualified health center | Other | Apr 23, 2014 |
| Macon County Health Department |
Federally qualified health center | Other | Apr 23, 2014 |
| Pickett County Health Department |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) Other (100%) |
Apr 23, 2014 Apr 23, 2014 |
| Putnam County Health Department |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) Other (100%) |
Apr 23, 2014 Apr 23, 2014 |
| Smith County Health Department |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) Other (100%) |
Apr 23, 2014 Apr 23, 2014 |
| Van Buren County Health Department |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) Other (100%) |
Apr 23, 2014 Apr 23, 2014 |
| White County Health Department |
Federally qualified health center | Other | Apr 23, 2014 |
| Gibson County Health Department/Community Health Center |
Federally qualified health center | Operational/Managerial Control (100%) | Aug 1, 2015 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20041013001259 | TN | Part B Supplier - Mass Immunization (Roster Biller Only) | 5698687077 | This NPI is an additional NPI on the enrollment |
| O20140324000163 | TN | Part a Provider - Federally Qualified Health Center (FQHC) | 5698687077 | Practice locations: McMinnville, TN |
National Provider Directory
- Tax ID family
- Trousdale County Health
Locations
1401 Sparta St
McMinnville, TN 37110
Phone (931) 473-8468
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Public Health or Welfare Agency | 251K00000X | |||
| Dental Clinic/Center | 261QD0000X | |||
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
1401 Sparta St
MC Minnville, TN 37110-1301
Mailing address
1100 England Drive
Cookeville, TN 38501-0924
Phone (931) 520-4201
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 444-7872 | Medicaid | TN |
Other names
- Warren County Health Department
Other providers in MC Minnville, TN
- Herbert X Smith
- Jacqueline T Smith
- Sandra Stafford
- Stanley R Martin, O.D.
- Melissa Beth Stanley
- Stewart Pharmacy, Inc.
- David E. Stewart
- Michael T. Stewart
- James Whitley Taylor
- Lea Taylor
All providers in MC Minnville, 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 Jan 7, 2025. 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.