NPIMap

Organization Active NPI

Maury Regional Hospital Marshall Medical Center

Doing business as MRMG Mob

  • Rural Health Clinic/Center
  • Columbia, TN
National Provider Identifier
1770103863
Registry record updated Jun 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MAURY REGIONAL HOSPITAL MARSHALL MEDICAL CENTER
Doing business as
MRMG Mob
Practice address
1222 Trotwood Ave Ste 101
Columbia, TN 38401-6404
Phone
(931) 490-7372
Fax
(931) 490-7379
NPI assigned
Apr 20, 2020
Last updated
Jun 3, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2025

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

Authorized official

Name
Gregory A Whitlock III
Title
VP Finance/It
Phone
(931) 540-4212

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Critical Care Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0200X
Pulmonary Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RP1001X
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X
Interventional Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0014X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

1222 Trotwood Ave Ste 101
Columbia, TN 38401-6404

Mailing address

PO Box 100054
Atlanta, GA 30348-0054
Phone (931) 490-1295

Other practice location 1

1222 Trotwood Ave Ste 503
Columbia, TN 38401-6422
Phone (931) 490-7775

Other practice location 2

1222 Trotwood Ave Ste 108
Columbia, TN 38401-6404
Phone (931) 380-4066

Other practice location 3

1222 Trotwood Ave Ste 400
Columbia, TN 38401-6436
Phone (931) 490-1295

Other names 1

  • MRMG MOB Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200720003712 TN Part A Provider - Rural Health Clinic 6406813781 Practice locations: Columbia, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1770103863. Details of each certification follow.

Rural health clinic certification: CCN 443463

Legal name
MAURY REGIONAL HOSPITAL MARSHALL MEDICAL CENTER
Doing business as
MRMG MOB
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 26, 2020
Last certification
Jun 26, 2020
Ownership / control type
2B
Organization structure
GovernmentNon-profit
Incorporated
Mar 13, 1995 in TN
Enrollment address
1222 Trotwood Ave
Ste 101
Columbia, TN 38401-6404
Related CCNs
441309

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 6

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

National Provider Directory

National Provider Directory
Tax ID family
Marshall Medical Ctr-DME10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

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
Richard D Schefke Individual Operational/Managerial ControlAssociate Chief Financial Officer Mar 25, 2025
Maury Regional Hospital Marshall Medical Center Organization, Columbia, TN Non-profit 5% Or Greater Direct Ownership Interest Jun 26, 2020 100%
Gregory Whitlock Individual Corporate DirectorVP Finance & It Apr 2, 2018
W-2 Managing EmployeeVP Finance & It Apr 2, 2018

Owners & managing parties with NPI records 6

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

Change-of-ownership history 2

DateEventCounterparty
Jun 26, 2020 Change of OwnershipThis provider was the buyer MRMG MobCCN 883823, TN, NPI 1770103863
Jun 26, 2020 Change of OwnershipThis provider was the seller MRMG MobCCN 443463, TN, NPI 1770103863

NPI Registry JSON

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

{
    "created_epoch": "1587340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748908800000",
    "number": "1770103863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 100054",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303480054",
            "telephone_number": "931-490-1295",
            "fax_number": "931-490-1298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1222 TROTWOOD AVE STE 101",
            "city": "COLUMBIA",
            "state": "TN",
            "postal_code": "384016404",
            "telephone_number": "931-490-7372",
            "fax_number": "931-490-7379"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1222 Trotwood Ave Ste 503",
            "address_purpose": "LOCATION",
            "city": "Columbia",
            "state": "TN",
            "postal_code": "384016422",
            "country_code": "US",
            "telephone_number": "931-490-7775",
            "fax_number": "931-490-7797",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1222 Trotwood Ave Ste 108",
            "address_purpose": "LOCATION",
            "city": "Columbia",
            "state": "TN",
            "postal_code": "384016404",
            "country_code": "US",
            "telephone_number": "931-380-4066",
            "fax_number": "931-380-4069",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1222 Trotwood Ave Ste 400",
            "address_purpose": "LOCATION",
            "city": "Columbia",
            "state": "TN",
            "postal_code": "384016436",
            "country_code": "US",
            "telephone_number": "931-490-1295",
            "fax_number": "931-490-1298",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MAURY REGIONAL HOSPITAL MARSHALL MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-20",
        "last_updated": "2025-06-03",
        "certification_date": "2025-06-03",
        "status": "A",
        "authorized_official_last_name": "WHITLOCK",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "VP FINANCE/IT",
        "authorized_official_telephone_number": "931-540-4212",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MRMG MOB",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Columbia, TN

Sources for this page

Verify at the official NPI Registry.