NPIMap

Organization Active NPI

Amg-Hillside LLC

Doing business as Southern Surgical

  • Surgery Physician
  • Pulaski, TN
National Provider Identifier
1073849634
Registry record updated Nov 2, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
39634 Issued in TN
Legal business name
AMG-HILLSIDE LLC
Doing business as
Southern Surgical
Practice address
204 Hillside Dr
Pulaski, TN 38478-4566
Phone
(931) 363-3514
Fax
(931) 363-3595
NPI assigned
Nov 2, 2009
Last updated
Nov 2, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2009

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

Authorized official

Name
Jess Judy
Title
President
Phone
(615) 372-8500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 39634 TN Primary

Addresses

Primary practice location

204 Hillside Dr
Pulaski, TN 38478-4566

Mailing address

204 Hillside Dr
Pulaski, TN 38478-4566
Phone (931) 363-3514

Other names 1

  • SOUTHERN SURGICAL Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070810000665 TN Part B Supplier - Clinic/Group Practice 9436240017 Receives reassigned benefits from 55 practitioners
20 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Pulaski, TN; Lynnville, TN; Lewisburg, TN; Lawrenceburg, TN; Ardmore, TN

Other NPIs on the same Medicare enrollment 20

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

View all 20

National Provider Directory

National Provider Directory
Tax ID family
Amg-Hillside LLC23 organizations share this tax ID, including this one

Other organizations with this tax ID 22

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

View all 22

Locations

204 Hillside Dr
Pulaski, TN 38478
Phone (931) 363-3514

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1257120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1257120000000",
    "number": "1073849634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 HILLSIDE DR",
            "city": "PULASKI",
            "state": "TN",
            "postal_code": "384784566",
            "telephone_number": "931-363-3514",
            "fax_number": "931-363-3595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 HILLSIDE DR",
            "city": "PULASKI",
            "state": "TN",
            "postal_code": "384784566",
            "telephone_number": "931-363-3514",
            "fax_number": "931-363-3595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMG-HILLSIDE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-02",
        "last_updated": "2009-11-02",
        "status": "A",
        "authorized_official_last_name": "JUDY",
        "authorized_official_first_name": "JESS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "615-372-8500"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "TN",
            "license": "39634",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SOUTHERN SURGICAL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pulaski, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.