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General NPI Number Information
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NPI Number | 1861468340
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Entity Type | Organization
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Legal Business Name | HARDEMAN COUNTY COMMUNITY HEALTH CENTER
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Dates
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Enumeration Date | 02/24/2006
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Last Update Date | 04/23/2025
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Provider Practice Location Address
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Address Line | 629 NUCKOLLS RD
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City | BOLIVAR
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State | TN
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Zip | 38008-1599
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Country | US
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Telephone | 731-658-3388
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Fax | 731-658-4079
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Provider Business Mailing Address
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Address Line | PO BOX 720
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City | BOLIVAR
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State | TN
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Zip | 38008-0720
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Country | US
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Telephone | 731-658-3388
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Fax | 731-658-4079
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MARY HEINZEN
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Credential |
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Telephone | 731-659-3114
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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