NPIMap

Organization Active NPI

Rural Health Services Consortium of Upper East Tennessee Inc

  • Federally Qualified Health Center (FQHC)
  • Greeneville, TN
National Provider Identifier
1891218160
Registry record updated Jul 19, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
RURAL HEALTH SERVICES CONSORTIUM OF UPPER EAST TENNESSEE INC
Practice address
2994 Camp Creek Rd
Camp Creek Medical Center
Greeneville, TN 37743
Phone
(423) 787-0680
Fax
(423) 787-7720
NPI assigned
Jul 19, 2017
Last updated
Jul 19, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2017

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

Authorized official

Name
Linda W Buck
Title
President/Ceo
Phone
(423) 272-9163

Specialties & licenses 1

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

Addresses

Primary practice location

2994 Camp Creek Rd
Camp Creek Medical Center
Greeneville, TN 37743

Mailing address

PO Box 850
Rogersville, TN 37857-0850
Phone (423) 272-9163

Other names 1

  • Camp Creek Medical Center Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171024002363 TN Part A Provider - Federally Qualified Health Center (FQHC) 0941118111 Practice locations: Greeneville, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1891218160. Details of each certification follow.

Federally qualified health center certification: CCN 441982

Legal name
RURAL HEALTH SERVICES CONSORTIUM OF UPPER EAST TENNESSEE INC
Doing business as
CAMP CREEK MEDICAL CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 24, 2017
Last certification
Oct 24, 2017
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 21, 1985 in TN
Enrollment address
2994 Camp Creek Rd
Greeneville, TN 37743-6064

Other NPIs with the same Medicare PAC ID 12

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

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
44D2133330Camp Creek Medical Center2994 Camp Creek Road, Greeneville, TN 37743Certificate of waiverJul 10, 2027

National Provider Directory

National Provider Directory
Tax ID family
Dry Creek Medical Cente6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Linda W. Buck Individual Corporate OfficerPresident/Ceo Jul 29, 2002
W-2 Managing EmployeePresidnet/Ceo Jul 29, 2002
Amelia E Bailey Individual Corporate DirectorBoard Member Mar 25, 2021
Silvia Fregoso Individual Corporate DirectorBoard Member Jul 24, 2006
Cloyce Eller Individual Corporate DirectorBoard Member Mar 27, 1999
Geren Michael Street Individual Corporate DirectorBoard Member Jul 23, 2020
Minnie Miller Individual Corporate DirectorBoard Member Apr 1, 2012
Terry Cunningham Individual Corporate DirectorBoard Member Jul 16, 2002
Jacqueline Charles Individual Corporate DirectorBoard Member Sep 23, 2004
Charles R Huffman Individual Corporate DirectorBoard Member Oct 24, 2019
Joseph Paul Frye Individual Corporate DirectorBoard Member Sep 23, 2004
Timothy R Smithson Individual Corporate DirectorBoard Member Apr 1, 2019
Betty Greene Individual Corporate DirectorBoard Member Jul 24, 2006
Charles Herman Heck Individual Corporate DirectorBoard Member Sep 22, 2016
Lorena Reynoso Individual Corporate DirectorBoard Member Jul 25, 2019

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Rogersville Medical ComplexRogersville, TN, CCN 441960 Federally qualified health center Operational/Managerial Control Dec 30, 2013

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

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

{
    "created_epoch": "1500422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1500422400000",
    "number": "1891218160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 850",
            "city": "ROGERSVILLE",
            "state": "TN",
            "postal_code": "378570850",
            "telephone_number": "423-272-9163",
            "fax_number": "423-921-6920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2994 CAMP CREEK RD",
            "address_2": "CAMP CREEK MEDICAL CENTER",
            "city": "GREENEVILLE",
            "state": "TN",
            "postal_code": "37743",
            "telephone_number": "423-787-0680",
            "fax_number": "423-787-7720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RURAL HEALTH SERVICES CONSORTIUM OF UPPER EAST TENNESSEE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-19",
        "last_updated": "2017-07-19",
        "status": "A",
        "authorized_official_last_name": "BUCK",
        "authorized_official_first_name": "LINDA",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "423-272-9163"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Camp Creek Medical Center",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Camp Creek Medical Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Greeneville, TN

Sources for this page

Verify at the official NPI Registry.