NPIMap

Organization Active NPI

Amg Crockett LLC

Doing business as Southern Tennessee Orthopedic and Spine Center

  • Orthopaedic Surgery Physician
  • Lawrenceburg, TN
National Provider Identifier
1457666372
Registry record updated Mar 2, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
AMG CROCKETT LLC
Doing business as
Southern Tennessee Orthopedic and Spine Center
Practice address
1605 S Locust Ave
Suite 101
Lawrenceburg, TN 38464-4061
Phone
(931) 762-4400
Fax
(931) 762-4499
NPI assigned
Aug 16, 2010
Last updated
Mar 2, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2015

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

Authorized official

Name
Dawn Cobb
Title
Cred Spec
Phone
(423) 364-4817

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X NU Primary

Addresses

Primary practice location

1605 S Locust Ave
Suite 101
Lawrenceburg, TN 38464-4061

Mailing address

1605 S Locust Ave
Suite 101
Lawrenceburg, TN 38464-4061
Phone (931) 762-4400

Other identifiers 1

IdentifierTypeStateIssuer
1520396MedicaidTN

Other names 1

  • Southern Tennessee Orthopedic and Spine Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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

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

NPI Registry JSON

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

{
    "created_epoch": "1281916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1425254400000",
    "number": "1457666372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1605 S LOCUST AVE",
            "address_2": "SUITE 101",
            "city": "LAWRENCEBURG",
            "state": "TN",
            "postal_code": "384644061",
            "telephone_number": "931-762-4400",
            "fax_number": "931-762-4499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1605 S LOCUST AVE",
            "address_2": "SUITE 101",
            "city": "LAWRENCEBURG",
            "state": "TN",
            "postal_code": "384644061",
            "telephone_number": "931-762-4400",
            "fax_number": "931-762-4499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMG CROCKETT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-16",
        "last_updated": "2015-03-02",
        "status": "A",
        "authorized_official_last_name": "COBB",
        "authorized_official_first_name": "DAWN",
        "authorized_official_title_or_position": "CRED SPEC",
        "authorized_official_telephone_number": "423-364-4817"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1520396",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern Tennessee Orthopedic and Spine Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lawrenceburg, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2015; 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.