Grundy County Health Services, Inc.
Organization Active NPI Family Nurse Practitioner · Tracy City, TN
NPI 1770588683 · NPPES record last updated Apr 1, 2025
Key facts
- NPI
- 1770588683
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- Legal business name
- GRUNDY COUNTY HEALTH SERVICES, INC.
- Practice address
- 740 Main St
Tracy City, TN 37387-4020 - Phone
- (931) 592-4242
- Fax
- (931) 592-4245
- NPI assigned
- Jun 16, 2005
- Organization subpart
- No
Authorized official
- Name
- Devon Brea Langley, FNP-C
- Title
- Nurse Practitioner- Provider
- Phone
- (931) 592-4242
Practitioners 4
-
Devon Langley, FNP-C
-
Eva Marie Black, FNP-BC
-
Tenzing Chounzom, MD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 44D0856990 | Tracy Clinic | Certificate of waiver | Jun 10, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240214004077 | TN | Part B Supplier - Clinic/Group Practice | 6800844200 |
Receives reassigned benefits from 2 practitioners Practice locations: Tracy City, TN |
National Provider Directory
Locations
740 Main St
Tracy City, TN 37387
Phone (931) 592-4242
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | Yes |
Addresses
Primary practice location
740 Main St
Tracy City, TN 37387-4020
Mailing address
740 Main St
PO Box 1449
Tracy City, TN 37387-1449
Phone (931) 592-4242
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| Q065726 | Medicaid | TN | |
| 1750962528 | Other | TN | NPI |
Other names
- Tracy Clinic
Other providers in Tracy City, TN
- Caresouth HHA Holdings of Winchester LLC
- Tonya L Ellis
- Matthew Leroy Griffith
- Devon Langley
- Randall Alan Littell
- Brandon Derrick Marshall
- Michael Yarworth
- Thomas F Phelps
All providers in Tracy City, TN · Family Nurse Practitioner in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 1, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.