NPIMap

Organization Active NPI

Hardeman County Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Bolivar, TN
National Provider Identifier
1861468340
Registry record updated Apr 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
HARDEMAN COUNTY COMMUNITY HEALTH CENTER
Practice address
629 Nuckolls Rd
Bolivar, TN 38008-1599
Phone
(731) 658-3388
Fax
(731) 658-4079
NPI assigned
Feb 24, 2006
Last updated
Apr 23, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2025

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

Authorized official

Name
Mary Heinzen
Title
Executive Director
Phone
(731) 659-3114

Specialties & licenses 1

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

Addresses

Primary practice location

629 Nuckolls Rd
Bolivar, TN 38008-1599

Mailing address

PO Box 720
Bolivar, TN 38008-0720
Phone (731) 658-3388

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040615001290 TN Part B Supplier - Clinic/Group Practice 5799694147 Receives reassigned benefits from 14 practitioners
4 other NPIs on this enrollment
Practice locations: Bolivar, TN; Stanton, TN; Henderson, TN
O20090922000725 TN Part A Provider - Federally Qualified Health Center (FQHC) 5799694147 Practice locations: Bolivar, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1861468340. Details of each certification follow.

Federally qualified health center certification: CCN 441861

Legal name
HARDEMAN COUNTY COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 15, 1992
Last certification
Oct 15, 1992
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 27, 1992 in TN
Enrollment address
629 Nuckolls Rd
Bolivar, TN 38008-1599

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory

Locations

629 Nuckolls Rd
Bolivar, TN 38008
Phone (731) 658-3388

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Marlita White Individual Corporate OfficerCeo Jan 14, 2019 100%
W-2 Managing Employee Jan 14, 2019
Linda D Lovelace Individual Corporate OfficerCfo Jul 28, 1997 100%
W-2 Managing Employee Sep 15, 2010
Delphus Hicks Individual Corporate Director Sep 15, 2010
Donna Pinner Individual Corporate DirectorDirector Aug 1, 2013
Darrell R Teubner Individual Corporate Director Sep 15, 2010
Barbara Hudson Individual Corporate Director Nov 1, 2011
Anita Parks Individual Corporate Director Oct 1, 2021
Ocie Holmes Individual Corporate Director Oct 15, 2017
Rosie Perry Individual Corporate Director Oct 1, 2021
Erma Williams Individual Corporate Director Sep 15, 2010
Linda Jones Individual Corporate DirectorDirector Feb 1, 2012

Practitioners & affiliated clinicians

Practitioners 40

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 40

NPI Registry JSON

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

{
    "created_epoch": "1140739200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745366400000",
    "number": "1861468340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 720",
            "city": "BOLIVAR",
            "state": "TN",
            "postal_code": "380080720",
            "telephone_number": "731-658-3388",
            "fax_number": "731-658-4079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "629 NUCKOLLS RD",
            "city": "BOLIVAR",
            "state": "TN",
            "postal_code": "380081599",
            "telephone_number": "731-658-3388",
            "fax_number": "731-658-4079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HARDEMAN COUNTY COMMUNITY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-24",
        "last_updated": "2025-04-23",
        "certification_date": "2025-04-23",
        "status": "A",
        "authorized_official_last_name": "HEINZEN",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "731-659-3114"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bolivar, TN

Sources for this page

Verify at the official NPI Registry.