NPIMap

Organization Active NPI

Amg-Hillside, LLC

Doing business as Ardmore Behavioral Health Clinic

  • Geriatric Psychiatry Physician
  • Pulaski, TN
National Provider Identifier
1588934673
Registry record updated Apr 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Psychiatry PhysicianTaxonomy code 2084P0805X
License
MD0000047963 Issued in TN
Legal business name
AMG-HILLSIDE, LLC
Doing business as
Ardmore Behavioral Health Clinic
Practice address
1265 E College St
Pulaski, TN 38478-4541
Phone
(931) 363-7531
NPI assigned
Jan 5, 2012
Last updated
Apr 30, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2012

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

Authorized official

Name
Michael Clark
Title
Vice President
Phone
(615) 372-8500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Psychiatry Physician 2084P0805X MD0000047963 TN Primary

Addresses

Primary practice location

1265 E College St
Pulaski, TN 38478-4541

Mailing address

PO Box 631
Pulaski, TN 38478-0631
Phone (931) 363-7531

Other names 1

  • Ardmore Behavioral Health Clinic 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

104 Ivy Ln
Pulaski, TN 38478
Phone (931) 292-6544

Practitioners & affiliated clinicians

Practitioners 2

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": "1325721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1335744000000",
    "number": "1588934673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 631",
            "city": "PULASKI",
            "state": "TN",
            "postal_code": "384780631",
            "telephone_number": "931-363-7531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1265 E COLLEGE ST",
            "city": "PULASKI",
            "state": "TN",
            "postal_code": "384784541",
            "telephone_number": "931-363-7531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMG-HILLSIDE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-05",
        "last_updated": "2012-04-30",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "615-372-8500"
    },
    "taxonomies": [
        {
            "code": "2084P0805X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Geriatric Psychiatry",
            "state": "TN",
            "license": "MD0000047963",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ardmore Behavioral Health Clinic",
            "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 Apr 30, 2012; 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.