NPIMap

Organization Active NPI

State of Tennessee

Doing business as Pickett County Health Department

  • Federally Qualified Health Center (FQHC)
  • Byrdstown, TN
National Provider Identifier
1730230558
Registry record updated Jan 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
STATE OF TENNESSEE
Doing business as
Pickett County Health Department
Practice address
1013 Woodlawn Dr
Byrdstown, TN 38549-2317
Phone
(931) 864-3178
Fax
(931) 864-3376
NPI assigned
Jan 16, 2007
Last updated
Jan 7, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2025

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

Authorized official

Name
Tammy Stewart
Title
Cfo
Phone
(931) 520-4203

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health or Welfare Agency 251K00000X NU
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

1013 Woodlawn Dr
Byrdstown, TN 38549-2317

Mailing address

1100 England Drive
Cookeville, TN 38501-0924
Phone (931) 520-4201

Other identifiers 1

IdentifierTypeStateIssuer
444-7868MedicaidTN

Other names 1

  • Pickett County Health Department Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041013001259 TN Part B Supplier - Mass Immunization (Roster Biller Only) 5698687077 This NPI is an additional NPI on the enrollment
O20140324000017 TN Part A Provider - Federally Qualified Health Center (FQHC) 5698687077 Practice locations: Byrdstown, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1730230558. Details of each certification follow.

Federally qualified health center certification: CCN 441841

Legal name
STATE OF TENNESSEE
Doing business as
PICKETT COUNTY HEALTH DEPARTMENT
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
Non-profit – corporation
Organization structure
OtherNon-profit
Enrollment address
1013 Woodlawn Dr
Byrdstown, TN 38549-2317

National Provider Directory

National Provider Directory
Tax ID family
Loudon County Health de202 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

1013 Woodlawn Dr
Byrdstown, TN 38549
Phone (931) 864-3178

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
State of Tennessee Organization, Cookeville, TN 5% Or Greater Direct Ownership Interest Apr 23, 2014 100%
Other Apr 23, 2014 100%
Tammy Stewart Individual Corporate OfficerChief Financial Officer Jan 15, 2020
W-2 Managing EmployeeAccountant 2 Jun 21, 2017
Deborah K Johnson Individual Corporate Director Jul 6, 2004
W-2 Managing EmployeeRegional Director Apr 30, 2014

All facility ownership & control disclosures 17

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

FacilityTypeRoleSince
Middle Tennessee Mental Health InstituteNashville, TN, CCN 444014 Hospital 5% Or Greater Direct Ownership Interest (100%) Nov 1, 1995
Moccasin Bend Mental Health InstituteChattanooga, TN, CCN 444002 Hospital Operational/Managerial Control (100%) Jul 1, 2008
Stewart County Community Medical CenterDover, TN, CCN 441848 Federally qualified health center Operational/Managerial Control (100%) Feb 19, 1987
Overton County Health DepartmentLivingston, TN, CCN 441840 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Other (100%)		 Apr 23, 2014
Apr 23, 2014
Cannon County Health DepartmentWoodbury, TN, CCN 441828 Federally qualified health center Other Apr 23, 2014
Clay County Health DepartmentCelina, TN, CCN 441831 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Other (100%)		 Apr 23, 2014
Apr 23, 2014
Cumberland County Health DepartmentCrossville, TN, CCN 441832 Federally qualified health center Other Apr 23, 2014
Dekalb County Health DepartmentSmithville, TN, CCN 441834 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Other (100%)		 Apr 23, 2014
Apr 23, 2014
Fentress County Health DepartmentJamestown, TN, CCN 441835 Federally qualified health center Other Apr 23, 2014
Jackson County Health DepartmentGainesboro, TN, CCN 441837 Federally qualified health center Other Apr 23, 2014
Macon County Health DepartmentLafayette, TN, CCN 441838 Federally qualified health center Other Apr 23, 2014
Putnam County Health DepartmentCookeville, TN, CCN 441842 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Other (100%)		 Apr 23, 2014
Apr 23, 2014
Smith County Health DepartmentCarthage, TN, CCN 441843 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Other (100%)		 Apr 23, 2014
Apr 23, 2014
Van Buren County Health DepartmentSpencer, TN, CCN 441844 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Other (100%)		 Apr 23, 2014
Apr 23, 2014
Warren County Health DepartmentMcMinnville, TN, CCN 441845 Federally qualified health center Other Apr 23, 2014
White County Health DepartmentSparta, TN, CCN 441847 Federally qualified health center Other Apr 23, 2014
Gibson County Health Department/Community Health CenterTrenton, TN, CCN 441968 Federally qualified health center Operational/Managerial Control (100%) Aug 1, 2015

Facilities with the same owner 10

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 5

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": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736208000000",
    "number": "1730230558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 ENGLAND DRIVE",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385010924",
            "telephone_number": "931-520-4201",
            "fax_number": "931-520-3871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1013 WOODLAWN DR",
            "city": "BYRDSTOWN",
            "state": "TN",
            "postal_code": "385492317",
            "telephone_number": "931-864-3178",
            "fax_number": "931-864-3376"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF TENNESSEE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2025-01-07",
        "certification_date": "2025-01-07",
        "status": "A",
        "authorized_official_last_name": "STEWART",
        "authorized_official_first_name": "TAMMY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "931-520-4203"
    },
    "taxonomies": [
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "444-7868",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pickett County Health Department",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Byrdstown, TN

Sources for this page

Verify at the official NPI Registry.