NPIMap

Organization Active NPI

Morgan County Health Council Inc

Doing business as Morgan County Medical Center

  • Federally Qualified Health Center (FQHC)
  • Wartburg, TN
National Provider Identifier
1720099419
Registry record updated Dec 19, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MORGAN COUNTY HEALTH COUNCIL INC
Doing business as
Morgan County Medical Center
Practice address
224 Old Mill Road
Wartburg, TN 37887
Phone
(423) 346-6221
Fax
(423) 346-5565
NPI assigned
Aug 10, 2006
Last updated
Dec 19, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2008

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

Authorized official

Name
Mrs. Kellie Jones
Title
Office Manager
Phone
(423) 346-6221

Specialties & licenses 1

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

Addresses

Primary practice location

224 Old Mill Road
Wartburg, TN 37887

Mailing address

224 Old Mill Road
P.O. Box 408
Wartburg, TN 37887
Phone (423) 346-6221

Other identifiers 1

IdentifierTypeStateIssuer
3375992OtherTNCIGNA MEDICARE

Other names 1

  • MORGAN COUNTY 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
O20040927000288 TN Part B Supplier - Clinic/Group Practice 6800865908 Receives reassigned benefits from 9 practitioners
Practice locations: Wartburg, TN
O20101122000292 TN Part A Provider - Federally Qualified Health Center (FQHC) 6800865908 Practice locations: Wartburg, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1720099419. Details of each certification follow.

Federally qualified health center certification: CCN 441819

Legal name
MORGAN COUNTY HEALTH COUNCIL INC
Doing business as
MORGAN COUNTY MEDICAL CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 1, 1992
Last certification
Jan 1, 1992
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 7, 1974 in TN
Enrollment address
224 Old Mill Rd
Wartburg, TN 37887-4163

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
44D0312208Morgan County Medical Center224 Old Mill Rd, Wartburg, TN 37887Certificate of waiverMay 15, 2027

National Provider Directory

National Provider Directory

Locations

224 Old Mill Rd
Wartburg, TN 37887
Phone (423) 346-6221

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Marsha Kelley Individual Corporate DirectorBoard Member Jul 1, 2014
Theresa Brock Individual Corporate OfficerCeo Apr 30, 2007
W-2 Managing EmployeeCeo Apr 30, 2007
Steve Walls Individual Corporate DirectorBoard Member Jul 1, 2014
Shelby Melhorn Individual Corporate DirectorBoard Member Jan 1, 2006
Marta Monroe Individual Corporate DirectorBoard Member Jul 1, 2014
Peggy Morgan Individual Corporate DirectorBoard Member Jan 1, 2001
Linda Taylor Individual Corporate DirectorBoard Member Jan 1, 2002
Brenda Melton Individual Corporate DirectorBoard Member Jan 1, 2008
David Hennessee Individual Corporate DirectorBoard Member Jan 1, 1993

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1229644800000",
    "number": "1720099419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "224 OLD MILL ROAD",
            "address_2": "P.O. BOX 408",
            "city": "WARTBURG",
            "state": "TN",
            "postal_code": "37887",
            "telephone_number": "423-346-6221",
            "fax_number": "423-346-5565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "224 OLD MILL ROAD",
            "city": "WARTBURG",
            "state": "TN",
            "postal_code": "37887",
            "telephone_number": "423-346-6221",
            "fax_number": "423-346-5565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MORGAN COUNTY HEALTH COUNCIL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-10",
        "last_updated": "2008-12-19",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "KELLIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "423-346-6221",
        "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": "CIGNA MEDICARE",
            "identifier": "3375992",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MORGAN COUNTY MEDICAL CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wartburg, TN

Sources for this page

Verify at the official NPI Registry.