Walter J Boyanton III, MD
Individual provider Active NPI Family Medicine Physician · Estill Springs, TN
NPI 1831135706 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1831135706
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- MD0000017539 (TN)
- Practice address
- 300 South Main St
Estill Springs, TN 37330-0700 - Phone
- (931) 649-5139
- Fax
- (931) 649-2766
- NPI assigned
- Jun 21, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 10
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 1981
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Amg-Southern Tennessee LLC
Practice addresses (Care Compare)
100 Hunters LN
Tullahoma, TN 37388-8263
Phone (931) 455-4616
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150729009219 | TN | Practitioner - Family Practice | 3870500119 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD0000017539 | TN | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Amg-Southern Tennessee LLC | Current |
Accepting new patients | |
| DX Mso, PLLC | Current |
Accepting new patients |
Locations
700 E 54th St N
Sioux Falls, SD 57104
Phone (423) 458-1426
1025 Peerless Xing NW
Cleveland, TN 37312
Phone (423) 476-5990
170 Mouse Creek Rd NW
Cleveland, TN 37312
Phone (423) 458-1426
2008 Decherd Blvd
Decherd, TN 37324
Phone (931) 962-9000
300 S Main St
Estill Springs, TN 37330
Phone (931) 649-5139
491 Majors Blvd
Lynchburg, TN 37352
Phone (931) 759-4727
100 Hunters Ln
Tullahoma, TN 37388
Phone (931) 455-4616
83 Memorial Dr
Winchester, TN 37398
Phone (931) 967-3966
186 Hospital Rd
Ste 200
Winchester, TN 37398
Phone (931) 962-9035
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MD0000017539 | TN | Yes |
Addresses
Primary practice location
300 South Main St
Estill Springs, TN 37330-0700
Mailing address
300 South Main Street
Estill Springs, TN 37330-0700
Phone (931) 649-5139
Other providers in Estill Springs, TN
- Allied Imaging LLC
- Allied Mobile Imaging, LLC
- Amg-Southern Tennessee LLC
- Robert Anderson
- Debra Jane Baxter
- Renate Marie Braddy
- James Randolph Bradford
- Rose Ann Bryant
- Tiffany Burris
- William Alan Cleek
All providers in Estill Springs, TN · Family Medicine Physician in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.