Amg Crockett LLC
Organization Active NPI Family Medicine Physician · Lawrenceburg, TN
NPI 1851531693 · NPPES record last updated Jun 25, 2009
Key facts
- NPI
- 1851531693
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- AMG CROCKETT LLC
- Practice address
- 184 Prosser Rd
Lawrenceburg, TN 38464-4233 - Phone
- (931) 762-1800
- Fax
- (615) 459-4531
- NPI assigned
- Mar 5, 2009
- Organization subpart
- No
Authorized official
- Name
- Mr. Michael B Clark
- Title
- President
- Phone
- (615) 459-4531
Other NPIs on the same Medicare enrollment 20
Practitioners 3
-
Amanda D Haneline, M.D.
-
Michael Quang-Minh Huynh, D.O.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
Locations
1611 S Locust Ave
Ste 200B
Lawrenceburg, TN 38464
Phone (931) 766-3664
1605 S Locust Ave
Lawrenceburg, TN 38464
Phone (931) 486-3840
1607 S Locust Ave
Ste 100
Lawrenceburg, TN 38464
2019 N Locust Ave
Lawrenceburg, TN 38464
Phone (931) 762-1800
206 S Military St
Loretto, TN 38469
Phone (931) 853-6136
175 Enoch Blvd
Savannah, TN 38372
Phone (319) 252-3007
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
184 Prosser Rd
Lawrenceburg, TN 38464-4233
Mailing address
184 Prosser Rd
Lawrenceburg, TN 38464-4233
Phone (931) 762-1800
Other names
- First Choice Health
Other providers in Lawrenceburg, TN
- Amanda Smith Optometry, PLLC
- Amg Crockett LLC
- Amg Crockett LLC
- Amg Crockett LLC
- Amg Crockett LLC
- Amg Crockett LLC
- Amg Crockett LLC
- Amg Crockett, LLC
- Amg Crockett, LLC
- Amg-Crockett, LLC
All providers in Lawrenceburg, 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 Jun 25, 2009. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.