NPIMap

Organization Active NPI

SHC Medical Partners of Tennessee, LLC

  • Nurse Practitioner
  • Mountain City, TN
National Provider Identifier
1609051895
Registry record updated Jul 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
0564617 Issued in TN
Legal business name
SHC MEDICAL PARTNERS OF TENNESSEE, LLC
Practice address
919 Medical Park Dr
Mountain City, TN 37683-1042
Phone
(423) 727-7800
Fax
(423) 727-2498
NPI assigned
Jan 7, 2008
Reactivated
Mar 15, 2019
Last updated
Jul 26, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
SHC MEDICAL PARTNERS, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 26, 2023

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

Authorized official

Name
Penny Carol Logan
Title
Chief Operating Officer
Phone
(502) 558-2193

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 0564617 TN Primary

Addresses

Primary practice location

919 Medical Park Dr
Mountain City, TN 37683-1042

Mailing address

805 N Whittington Pkwy
Louisville, KY 40222-7101
Phone (502) 630-7532

Other identifiers 1

IdentifierTypeStateIssuer
1506049OtherTNGROUP MEDICAID NUMBER

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080318000852 TN Part B Supplier - Clinic/Group Practice 1951487826 Receives reassigned benefits from 67 practitioners
Practice locations: Monteagle, TN; Westmoreland, TN; Monterey, TN; Mountain City, TN; Nashville, TN; Oak Ridge, TN; Pigeon Forge, TN; Portland, TN…

National Provider Directory

National Provider Directory
Part of
SHC Medical Partners LLC

Locations

1410 Trotwood Ave
Columbia, TN 38401
Phone (931) 388-6443

1500 W Elk Ave
Ste 109
Elizabethton, TN 37643

410 W Crawford Ave
Monterey, TN 38574
Phone (931) 537-6524

Practitioners & affiliated clinicians

Practitioners 70

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.

View all 70

NPI Registry JSON

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

{
    "created_epoch": "1199664000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690329600000",
    "number": "1609051895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 N WHITTINGTON PKWY",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402227101",
            "telephone_number": "502-630-7532",
            "fax_number": "502-568-7121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "919 MEDICAL PARK DR",
            "city": "MOUNTAIN CITY",
            "state": "TN",
            "postal_code": "376831042",
            "telephone_number": "423-727-7800",
            "fax_number": "423-727-2498"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHC MEDICAL PARTNERS OF TENNESSEE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SHC MEDICAL PARTNERS, LLC",
        "enumeration_date": "2008-01-07",
        "last_updated": "2023-07-26",
        "certification_date": "2023-07-26",
        "deactivation_date": "2019-03-06",
        "reactivation_date": "2019-03-15",
        "status": "A",
        "authorized_official_last_name": "LOGAN",
        "authorized_official_first_name": "PENNY",
        "authorized_official_middle_name": "CAROL",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "502-558-2193"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TN",
            "license": "0564617",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP MEDICAID NUMBER",
            "identifier": "1506049",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mountain City, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.