Amg-Southern Tennessee LLC
Organization Active NPI Family Nurse Practitioner · Coalmont, TN
NPI 1992966097 · NPPES record last updated Jun 20, 2008
Key facts
- NPI
- 1992966097
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- Legal business name
- AMG-SOUTHERN TENNESSEE LLC
- Practice address
- 68 South Industrial Park Road
Coalmont, TN 37313 - Phone
- (931) 692-0010
- Fax
- (931) 692-0012
- NPI assigned
- Jun 20, 2008
- Organization subpart
- Yes
- Parent organization (as reported)
- AMG-SOUTHERN TENNESSEE LLC
Authorized official
- Name
- William Gracey
- Title
- Coo
- Phone
- (615) 372-8500
Other NPIs on the same Medicare enrollment 41
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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… |
National Provider Directory
- Part of
- Amg-Southern Tennessee LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner |
363LF0000X | Yes |
Addresses
Primary practice location
68 South Industrial Park Road
Coalmont, TN 37313
Mailing address
PO Box 68
Coalmont, TN 37313-0068
Phone (931) 692-0010
Other names
- Coalmont Clinic
NPI Registry JSON
{
"created_epoch": "1213920000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1213920000000",
"number": "1992966097",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 68",
"city": "COALMONT",
"state": "TN",
"postal_code": "373130068",
"telephone_number": "931-692-0010",
"fax_number": "931-692-0012"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "68 SOUTH INDUSTRIAL PARK ROAD",
"city": "COALMONT",
"state": "TN",
"postal_code": "37313",
"telephone_number": "931-692-0010",
"fax_number": "931-692-0012"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "AMG-SOUTHERN TENNESSEE LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "AMG-SOUTHERN TENNESSEE LLC",
"enumeration_date": "2008-06-20",
"last_updated": "2008-06-20",
"status": "A",
"authorized_official_last_name": "GRACEY",
"authorized_official_first_name": "WILLIAM",
"authorized_official_title_or_position": "COO",
"authorized_official_telephone_number": "615-372-8500"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Nurse Practitioner, Family",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Coalmont Clinic",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Coalmont, TN
- Coalmont Clinic
- Exceptional Enterprises, Inc.
- Franklin Emergency Medical Services, Inc.
- Grundy Emergency Medical Service Inc
- Jessica Joslyn
All providers in Coalmont, TN · Family Nurse Practitioner 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 20, 2008. 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.