Amg Crockett LLC
Organization Active NPI Cardiovascular Disease Physician · Lawrenceburg, TN
NPI 1013374073 · NPPES record last updated Jan 21, 2016
Key facts
- NPI
- 1013374073
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Cardiovascular Disease Physician 207RC0000X
- Legal business name
- AMG CROCKETT LLC
- Practice address
- 1611 S Locust Ave
Suite 200B
Lawrenceburg, TN 38464-4055 - Phone
- (931) 766-3684
- NPI assigned
- Jan 21, 2016
- Organization subpart
- No
Authorized official
- Name
- Casey J. Willis
- Title
- Market Manager
- Phone
- (931) 766-4574
Other NPIs on the same Medicare enrollment 20
Practitioners 1
-
Douglas Peter Ead, FNP - C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20071017000313 | TN | Part B Supplier - Clinic/Group Practice | 4789770199 |
Receives reassigned benefits from 92 practitioners 20 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Lawrenceburg, TN; Winchester, TN; Pulaski, TN; Mt Pleasant, TN; Loretto, TN; Decherd, TN |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cardiovascular Disease Physician |
207RC0000X | Yes |
Addresses
Primary practice location
1611 S Locust Ave
Suite 200B
Lawrenceburg, TN 38464-4055
Mailing address
1611 S Locust Ave
Suite 200B
Lawrenceburg, TN 38464-4055
Phone (931) 766-3684
Other names
- SOUTHERN TENNESSEE HEART
Other providers in Lawrenceburg, TN
- Karlee Brook Allen
- Christy Auburn Alley
- Aloe Mental Health PLLC
- Haley Alsup
- Amanda Smith Optometry, PLLC
- Amg Crockett LLC
- Amg Crockett LLC
- Amg Crockett LLC
- Amg Crockett LLC
- Amg Crockett LLC
All providers in Lawrenceburg, TN · Cardiovascular Disease Physician in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 21, 2016. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.