Maury Regional Hospital
Organization Active NPI Federally Qualified Health Center (FQHC) · Waynesboro, TN
NPI 1669983995 · NPPES record last updated Aug 8, 2024
Key facts
- NPI
- 1669983995
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- MAURY REGIONAL HOSPITAL
- Practice address
- 321 Dexter L Woods Memorial Blvd Ste E
Waynesboro, TN 38485-2418 - Phone
- (931) 722-9999
- Fax
- (931) 722-2049
- NPI assigned
- Oct 13, 2017
- Organization subpart
- Yes
- Parent organization (as reported)
- MAURY REGIONAL HOSPITAL
Authorized official
- Name
- Charles J Brinkley III
- Title
- Cfo
- Phone
- (931) 540-4212
Owned or controlled facilities with NPI records 5
Other NPIs on the same Medicare enrollment 5
Other NPIs with the same Medicare PAC ID 6
Corporate family (same tax ID) 15
Facilities with the same owner 8
Practitioners 34
-
Paula A Cole, APN
-
Madalyn Rae Gold Amis, FNP-C
-
Schelby Hanson Blair, PMHNP-C
-
Rebecca Brady, FNP
-
Charles Cantieri, DO
-
Carly Ann Cooke, FNP-BC
-
Sandra Kilburn Daniel, ACNP-BC
-
Loretta L. Davidson, N.P.
-
John Mason Douglas, FNP-BC
-
Kimberly Fowler Huffman, RN, MSN, APRN
-
Jawaid Kamal, MD
-
Sarah S Kersey, PA-C
-
Christian Maurer, MD
-
Brandy L Miller, NP-C
-
Lauren Rhea Miller, D.O.
-
Timothy A Nash, M.D.
-
Theresa Norris, MSN
-
Julie Prinzo, RN
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 44D0882921 | Maury Regional Hospital Dba Primary Care | Certificate of waiver | Feb 18, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TN
Federally qualified health center certification: CCN 441983
- Legal name
- MAURY REGIONAL HOSPITAL
- Doing business as
- PRIMARY CARE FEDERALLY QUALIFIED HEALTH CENTER- WAYNESBORO
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Apr 5, 2018
- Last certification
- Apr 5, 2018
- Ownership / control type
- For profit – corporation
- Organization structure
- Government · Non-profit
- Enrollment address
- 321 Dexter L Woods Memorial Blvd
Ste E
Waynesboro, TN 38485-2418
All disclosed owners & managing parties 3
| Name | Role | Since | Share |
|---|---|---|---|
| Richard D Schefke |
Operational/Managerial Control |
Mar 25, 2025 | |
| Maury County Government |
5% Or Greater Direct Ownership Interest | Sep 14, 2017 | 100% |
| Gregory Whitlock |
Corporate Director |
Apr 2, 2018 | |
| W-2 Managing Employee |
Apr 2, 2018 |
All facility ownership & control disclosures 5
| Facility | Type | Role | Since |
|---|---|---|---|
| NHC-Maury Regional Transitional Care Center |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (20%) Operational/Managerial Control |
Jan 1, 2017 Jan 1, 2017 |
| Maury Regional Urgent Care North |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Jun 26, 2020 |
| Maury Regional Urgent Care Columbia |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Jun 26, 2020 |
| MRMG Mt Pleasant |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Jun 26, 2020 |
| MRMG Spring Hill |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Jun 26, 2020 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040330001709 | TN | Part B Supplier - Clinic/Group Practice | 4688569718 |
Receives reassigned benefits from 54 practitioners 5 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Lewisburg, TN; Waynesboro, TN; Spring Hill, TN; Hohenwald, TN; Ethridge, TN; Columbia, TN; Collinwood, TN |
| O20180103002487 | TN | Part a Provider - Federally Qualified Health Center (FQHC) | 4688569718 | Practice locations: Waynesboro, TN |
National Provider Directory
- Tax ID family
- Maury Regional Hospital
- Part of
- Maury Regional Hospital
Locations
321 Dexter L Woods Memorial Blvd
#E
Waynesboro, TN 38485
Phone (931) 722-9999
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
321 Dexter L Woods Memorial Blvd Ste E
Waynesboro, TN 38485-2418
Mailing address
PO Box 100054
Atlanta, GA 30348-0054
Phone (931) 796-4901
Other names
- Primary Care Federally Qualified Health Center - Waynesboro
Other providers in Waynesboro, TN
- Matt Lineberry
- Alden Littlejohn
- Abbie Lyn Love
- Loving Care Assisted Living LLC
- Maury Regional Hospital
- Maury Regional Hospital
- Pamela Jean May
- Medi-Serv. Inc.
- Kelsey L Mercer
- Cayley Jae Merriman
All providers in Waynesboro, 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 Aug 8, 2024. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.