Active NPI
Amg-Livingston LLC
- Obstetrics & Gynecology Physician
- Livingston, TN
National Provider Identifier
1154595502
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Obstetrics & Gynecology Physician
- Legal business name
- AMG-LIVINGSTON LLC
- Practice address
- 700 W Main St
Livingston, TN 38570-1720 - Phone
- (931) 823-9970
- Fax
- (931) 823-9006
- NPI assigned
- Apr 16, 2008
- Organization subpart
- Yes
- Parent organization
- AMG-LIVINGSTON LLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- William M Gracey
- Title
- Coo
- Phone
- (615) 372-8500
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | Primary |
Addresses
Primary practice location
700 W Main St
Livingston, TN 38570-1720
Mailing address
700 W Main St
Livingston, TN 38570-1720
Phone (931) 823-9970
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 621753651 | Other | TN | TAX ID |
Other names 1
- Upper Cumberland Center for Women
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031120000923 | TN | Part B Supplier - Clinic/Group Practice | 1052225760 |
Receives reassigned benefits from 36 practitioners 7 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Cookeville, TN; Livingston, TN; Celina, TN; Byrdstown, TN |
Other NPIs on the same Medicare enrollment 7
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider Directory- Part of
- Amg-Livingston LLC
Locations
700 W Main St
Livingston, TN 38570
Phone (931) 823-9970
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1208304000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1213660800000",
"number": "1154595502",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "700 W MAIN ST",
"city": "LIVINGSTON",
"state": "TN",
"postal_code": "385701720",
"telephone_number": "931-823-9970",
"fax_number": "931-823-9006"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "700 W MAIN ST",
"city": "LIVINGSTON",
"state": "TN",
"postal_code": "385701720",
"telephone_number": "931-823-9970",
"fax_number": "931-823-9006"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "AMG-LIVINGSTON LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "AMG-LIVINGSTON LLC",
"enumeration_date": "2008-04-16",
"last_updated": "2008-06-17",
"status": "A",
"authorized_official_last_name": "GRACEY",
"authorized_official_first_name": "WILLIAM",
"authorized_official_middle_name": "M",
"authorized_official_title_or_position": "COO",
"authorized_official_telephone_number": "615-372-8500"
},
"taxonomies": [
{
"code": "207V00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Obstetrics & Gynecology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID",
"identifier": "621753651",
"state": "TN"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Upper Cumberland Center for Women",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Livingston, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 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.