NPIMap

Organization Active NPI

Amg - Southern Tennessee, LLC

Doing business as Southern Tennessee Primary Care - Premier Family Healthcare

  • Family Nurse Practitioner
  • Tullahoma, TN
National Provider Identifier
1942744339
Registry record updated Dec 5, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
Legal business name
AMG - SOUTHERN TENNESSEE, LLC
Doing business as
Southern Tennessee Primary Care - Premier Family Healthcare
Practice address
108 W Blackwell St
Tullahoma, TN 37388-3505
Phone
(931) 841-3821
Fax
(931) 841-3869
NPI assigned
Dec 5, 2016
Last updated
Dec 5, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2016

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

Authorized official

Name
Jess N Judy
Title
President
Phone
(615) 920-7214

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X NU Primary

Addresses

Primary practice location

108 W Blackwell St
Tullahoma, TN 37388-3505

Mailing address

PO Box 399
Winchester, TN 37398-0399
Phone (931) 841-3821

Other names 1

  • Southern Tennessee Primary Care - Premier Family Healthcare Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041013001206 TN Part B Supplier - Clinic/Group Practice 5991765943 Receives reassigned benefits from 112 practitioners
41 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Tullahoma, TN; Winchester, TN; Decherd, TN; Estill Springs, TN; Fayetteville, TN; Huntland, TN; Lawrenceburg, TN; Lynchburg, TN…

Other NPIs on the same Medicare enrollment 41

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 41

National Provider Directory

National Provider Directory

Locations

108 W Blackwell St
Tullahoma, TN 37388
Phone (931) 841-3821

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": "1480896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480896000000",
    "number": "1942744339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 399",
            "city": "WINCHESTER",
            "state": "TN",
            "postal_code": "373980399",
            "telephone_number": "931-841-3821",
            "fax_number": "931-841-3869"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 W BLACKWELL ST",
            "city": "TULLAHOMA",
            "state": "TN",
            "postal_code": "373883505",
            "telephone_number": "931-841-3821",
            "fax_number": "931-841-3869"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMG - SOUTHERN TENNESSEE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-05",
        "last_updated": "2016-12-05",
        "status": "A",
        "authorized_official_last_name": "JUDY",
        "authorized_official_first_name": "JESS",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "615-920-7214"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern Tennessee Primary Care - Premier Family Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tullahoma, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2016; 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.