Healthcare Provider Details

I. General information

NPI: 1659875227
Provider Name (Legal Business Name): HARDEMAN COUNTY COMMUNITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 NUCKOLLS RD
BOLIVAR TN
38008-1539
US

IV. Provider business mailing address

PO BOX 720
BOLIVAR TN
38008-0720
US

V. Phone/Fax

Practice location:
  • Phone: 731-658-3388
  • Fax:
Mailing address:
  • Phone: 731-658-3388
  • Fax: 731-659-3131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LINDA D LOVELACE
Title or Position: CFO
Credential:
Phone: 731-658-3388