NPIMap

Organization Active NPI

Rural Health Services Consortium of Upper East Tennessee Inc

Doing business as Mountain City Medical Center

  • Federally Qualified Health Center (FQHC)
  • Mountain City, TN
National Provider Identifier
1720088537
Registry record updated Oct 10, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
RURAL HEALTH SERVICES CONSORTIUM OF UPPER EAST TENNESSEE INC
Doing business as
Mountain City Medical Center
Practice address
222 Oak St
Mountain City, TN 37683-1526
Phone
(423) 727-6319
Fax
(423) 727-4164
NPI assigned
Jul 22, 2005
Last updated
Oct 10, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2008

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

Authorized official

Name
Mrs. Linda W Buck
Title
Ceo
Phone
(423) 272-9163

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

222 Oak St
Mountain City, TN 37683-1526

Mailing address

PO Box 850
Rogersville, TN 37857-0850
Phone (423) 272-9163

Other identifiers 5

IdentifierTypeStateIssuer
020845900OtherBLACKLUNG
3703867OtherCIGNA/MEDICARE
4448155MedicaidTN
4122525OtherTNBLUECROSS BLUESHIELD
004OtherCHAMPUS PROVIDER

Other names 1

  • Mountain City Medical Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031107000207 TN Part B Supplier - Clinic/Group Practice 0941118111 Receives reassigned benefits from 54 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Rogersville, TN; Sneedville, TN; Kingsport, TN
O20040505000964 TN Part A Provider - Federally Qualified Health Center (FQHC) 0941118111 Practice locations: Mountain City, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1720088537. Details of each certification follow.

Federally qualified health center certification: CCN 441816

Legal name
RURAL HEALTH SERVICES CONSORTIUM OF UPPER EAST TENNESSEE INC
Doing business as
MOUNTAIN CITY MEDICAL CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 21, 1985 in TN
Enrollment address
222 Oak St
Mountain City, TN 37683-1526

Other NPIs with the same Medicare PAC ID 12

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

Other NPIs on the same Medicare enrollment 13

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

View all 13

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
44D0311209Rural Health Services Consortium, Inc222 Oak Street, Mountain City, TN 37683ComplianceJun 10, 2028

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Linda W. Buck Individual Corporate OfficerPresident/Ceo Jul 29, 2002
W-2 Managing Employee Jul 29, 2002
Amelia E Bailey Individual Corporate DirectorBoard Member Mar 25, 2021
Cloyce Eller Individual Corporate DirectorBoard Member Mar 27, 1999
Geren Michael Street Individual Corporate DirectorBoard Member Jul 23, 2020
Minnie Miller Individual Corporate DirectorBoard Member Apr 1, 2012
Terry Cunningham Individual Corporate DirectorBoard Member Jul 16, 2002
Jacqueline Charles Individual Corporate DirectorBoard Member Sep 23, 2004
Charles R Huffman Individual Corporate DirectorBoard Member Oct 24, 2019
Joseph Paul Frye Individual Corporate DirectorBoard Member Sep 23, 2004
Timothy R Smithson Individual Corporate DirectorBoard Member Apr 1, 2019
Betty Greene Individual Corporate DirectorBoard Member Jul 24, 2006
Charles Herman Heck Individual Corporate DirectorBoard Member Sep 22, 2016
Lorena Reynoso Individual Corporate DirectorBoard Member Jul 25, 2019

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Rogersville Medical ComplexRogersville, TN, CCN 441960 Federally qualified health center Operational/Managerial Control Dec 30, 2013

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

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

{
    "created_epoch": "1121990400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1223596800000",
    "number": "1720088537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 850",
            "city": "ROGERSVILLE",
            "state": "TN",
            "postal_code": "378570850",
            "telephone_number": "423-272-9163",
            "fax_number": "423-921-6920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 OAK ST",
            "city": "MOUNTAIN CITY",
            "state": "TN",
            "postal_code": "376831526",
            "telephone_number": "423-727-6319",
            "fax_number": "423-727-4164"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RURAL HEALTH SERVICES CONSORTIUM OF UPPER EAST TENNESSEE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-22",
        "last_updated": "2008-10-10",
        "status": "A",
        "authorized_official_last_name": "BUCK",
        "authorized_official_first_name": "LINDA",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "423-272-9163",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLACKLUNG",
            "identifier": "020845900",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA/MEDICARE",
            "identifier": "3703867",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4448155",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS BLUESHIELD",
            "identifier": "4122525",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHAMPUS PROVIDER",
            "identifier": "004",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mountain City Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mountain City, TN

Sources for this page

Verify at the official NPI Registry.