NPIMap

Organization Active NPI

Woodland Wellness, Inc

  • Rural Health Clinic/Center
  • Tullahoma, TN
National Provider Identifier
1699545780
Registry record updated Jan 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
WOODLAND WELLNESS, INC
Practice address
501 N Jackson St
Tullahoma, TN 37388-3510
Phone
(931) 954-5219
Fax
(931) 999-1454
NPI assigned
Jan 8, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2024

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

Authorized official

Name
Dana A Talley
Title
Administrator
Phone
(931) 408-0585

Specialties & licenses 1

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

Addresses

Primary practice location

501 N Jackson St
Tullahoma, TN 37388-3510

Mailing address

501 N Jackson St
Tullahoma, TN 37388-3510
Phone (931) 954-5219

Other names 1

  • Woodland Wellness 0f Tullahoma Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240611003287 TN Part A Provider - Rural Health Clinic 3678824927 Practice locations: Tullahoma, TN

Rural health clinic certification: CCN 888920

Legal name
WOODLAND WELLNESS INC
Doing business as
WOODLAND WELLNESS OF TULLAHOMA
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 26, 2024
Last certification
Nov 26, 2024
Ownership / control type
1B
Organization structure
CorporationProprietary
Enrollment address
501 N Jackson St
Tullahoma, TN 37388-3510

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

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
44D2298180Woodland Wellness of Tullahoma501 N Jackson Street, Tullahoma, TN 37388Certificate of waiverJan 29, 2028

National Provider Directory

National Provider Directory

Locations

501 N Jackson St
Tullahoma, TN 37388
Phone (931) 222-4213

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Dana Alan Talley Individual W-2 Managing EmployeeAd; Mar 23, 2018 50%
Laura B Talley Individual Contracted Managing EmployeeVice President Mar 23, 2018 50%
5% Or Greater Direct Ownership Interest Mar 23, 2018 50%
Corporate OfficerVice President Mar 3, 2018 50%
Mark a Vann Individual 5% Or Greater Direct Ownership Interest Mar 23, 2018 50%
Corporate OfficerPresident Mar 23, 2018 50%
W-2 Managing EmployeeAprn-Family Nurse Practitioner Mar 23, 2018 50%

Owners & managing parties with NPI records 1

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

  • Mark A Vann, FNP-BC
    • Family Nurse Practitioner
    • Decherd, TN
    • NPI 1194036327

    5% Or Greater Direct Ownership Interest, Corporate Officer, W-2 Managing Employee

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 4

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": "1704672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704672000000",
    "number": "1699545780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 N JACKSON ST",
            "city": "TULLAHOMA",
            "state": "TN",
            "postal_code": "373883510",
            "telephone_number": "931-954-5219",
            "fax_number": "931-999-1454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 N JACKSON ST",
            "city": "TULLAHOMA",
            "state": "TN",
            "postal_code": "373883510",
            "telephone_number": "931-954-5219",
            "fax_number": "931-999-1454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOODLAND WELLNESS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-08",
        "last_updated": "2024-01-08",
        "certification_date": "2024-01-08",
        "status": "A",
        "authorized_official_last_name": "TALLEY",
        "authorized_official_first_name": "DANA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "931-408-0585"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Woodland Wellness 0f Tullahoma",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tullahoma, TN

Sources for this page

Verify at the official NPI Registry.