Provider Demographics
NPI:1477855112
Name:AMG SOUTHERN TN, LLC
Entity Type:Organization
Organization Name:AMG SOUTHERN TN, LLC
Other - Org Name:PALMER MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:MEKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-779-3691
Mailing Address - Street 1:2578 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:TN
Mailing Address - Zip Code:37365-2730
Mailing Address - Country:US
Mailing Address - Phone:931-779-3691
Mailing Address - Fax:931-779-3690
Practice Address - Street 1:2578 MAIN ST
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:TN
Practice Address - Zip Code:37365-2730
Practice Address - Country:US
Practice Address - Phone:931-779-3691
Practice Address - Fax:931-779-3690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-01
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty