NPIMap

Organization Active NPI

Amg-Southern Tennessee LLC

Doing business as Coalmont Clinic

  • Family Nurse Practitioner
  • Coalmont, TN
National Provider Identifier
1992966097
Registry record updated Jun 20, 2008
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
Coalmont Clinic
Practice address
68 South Industrial Park Road
Coalmont, TN 37313
Phone
(931) 692-0010
Fax
(931) 692-0012
NPI assigned
Jun 20, 2008
Last updated
Jun 20, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
AMG-SOUTHERN TENNESSEE LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 20, 2008

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

Authorized official

Name
William Gracey
Title
Coo
Phone
(615) 372-8500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X Primary

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 1

  • Coalmont Clinic 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
Part of
Northlake Medical Clini

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "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": "",
            "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

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2008; 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.