NPIMap

Organization Active NPI

Amg-Southern Tennessee LLC

  • Surgery Physician
  • Winchester, TN
National Provider Identifier
1093926404
Registry record updated Apr 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
AMG-SOUTHERN TENNESSEE LLC
Practice address
83 Memorial Dr
Winchester, TN 37398-2401
Phone
(931) 967-3966
Fax
(931) 962-0373
NPI assigned
May 25, 2007
Last updated
Apr 20, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
AMG-SOUTHERN TENNESSEE LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 20, 2008

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

Authorized official

Name
William Gracecy
Title
Coo
Phone
(615) 372-8500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X NU Primary

Addresses

Primary practice location

83 Memorial Dr
Winchester, TN 37398-2401

Mailing address

83 Memorial Dr
Winchester, TN 37398-2401
Phone (931) 967-3966

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041013001206 TN Part B Supplier - Clinic/Group Practice 5991765943 Receives reassigned benefits from 112 practitioners
41 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Tullahoma, TN; Winchester, TN; Decherd, TN; Estill Springs, TN; Fayetteville, TN; Huntland, TN; Lawrenceburg, TN; Lynchburg, TN…

Other NPIs on the same Medicare enrollment 41

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

View all 41

National Provider Directory

National Provider Directory
Part of
Amg Southern Tennessee LLC

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": "1180051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1093926404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "83 MEMORIAL DR",
            "city": "WINCHESTER",
            "state": "TN",
            "postal_code": "373982401",
            "telephone_number": "931-967-3966",
            "fax_number": "931-962-0373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "83 MEMORIAL DR",
            "city": "WINCHESTER",
            "state": "TN",
            "postal_code": "373982401",
            "telephone_number": "931-967-3966",
            "fax_number": "931-962-0373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMG-SOUTHERN TENNESSEE LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "AMG-SOUTHERN TENNESSEE LLC",
        "enumeration_date": "2007-05-25",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "GRACECY",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "615-372-8500"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winchester, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; 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.