Provider Demographics
NPI:1689968109
Name:AMG-HILLSIDE, LLC
Entity Type:Organization
Organization Name:AMG-HILLSIDE, LLC
Other - Org Name:SOUTHERN TENNESSEE SURGICAL SERVICES-PULASKI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JESS
Authorized Official - Middle Name:
Authorized Official - Last Name:JUDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-372-8500
Mailing Address - Street 1:PO BOX 635
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:TN
Mailing Address - Zip Code:38478-0635
Mailing Address - Country:US
Mailing Address - Phone:931-363-9308
Mailing Address - Fax:931-363-9430
Practice Address - Street 1:1255 E COLLEGE ST
Practice Address - Street 2:SUITE 500
Practice Address - City:PULASKI
Practice Address - State:TN
Practice Address - Zip Code:38478-4515
Practice Address - Country:US
Practice Address - Phone:931-363-8055
Practice Address - Fax:931-363-8056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-01
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty