NPIMap

Organization Active NPI

Perry County Medical Center, Inc.

  • General Practice Dentistry
  • Lyles, TN
National Provider Identifier
1710535703
Registry record updated Aug 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
PERRY COUNTY MEDICAL CENTER, INC.
Practice address
7723 Clearview Church LN Ste 200
Lyles, TN 37098-1674
Phone
(931) 670-8318
NPI assigned
Sep 3, 2019
Last updated
Aug 13, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
THREE RIVERS COMMUNITY HEALTH GROUPAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 13, 2020

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

Authorized official

Name
Phillip Bradley TatumNPI 1992736334
Title
Ceo
Phone
(931) 589-2104

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

7723 Clearview Church LN Ste 200
Lyles, TN 37098-1674

Mailing address

PO Box 916
Linden, TN 37096-0916
Phone (931) 589-2104

Other names 1

  • Three Rivers Community Health Dental Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070303000037 TN Part B Supplier - Clinic/Group Practice 4981706330 Receives reassigned benefits from 18 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Linden, TN; Lyles, TN

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Perry County Medical Center4 organizations share this tax ID, including this one
Part of
Perry County Medical Center

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

153 W Main St
Ste 100
Linden, TN 37096
Phone (931) 589-2104

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/1954/brand/1/csg/41/fhir/r4

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1567468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597276800000",
    "number": "1710535703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 916",
            "city": "LINDEN",
            "state": "TN",
            "postal_code": "370960916",
            "telephone_number": "931-589-2104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7723 CLEARVIEW CHURCH LN STE 200",
            "city": "LYLES",
            "state": "TN",
            "postal_code": "370981674",
            "telephone_number": "931-670-8318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERRY COUNTY MEDICAL CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THREE RIVERS COMMUNITY HEALTH GROUP",
        "enumeration_date": "2019-09-03",
        "last_updated": "2020-08-13",
        "certification_date": "2020-08-13",
        "status": "A",
        "authorized_official_last_name": "TATUM",
        "authorized_official_first_name": "PHILLIP",
        "authorized_official_middle_name": "BRADLEY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "931-589-2104"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Three Rivers Community Health Dental",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Lyles, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2020; 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.