Provider Demographics
NPI:1710105499
Name:AMG-HILLSIDE LLC
Entity Type:Organization
Organization Name:AMG-HILLSIDE LLC
Other - Org Name:GILES COUNTY ORTHOPAEDIC AND JOINT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIVISION PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-372-8503
Mailing Address - Street 1:PO BOX 621
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:TN
Mailing Address - Zip Code:38478-0621
Mailing Address - Country:US
Mailing Address - Phone:931-363-3514
Mailing Address - Fax:931-363-3595
Practice Address - Street 1:204 HILLSIDE DRIVE
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:TN
Practice Address - Zip Code:38478
Practice Address - Country:US
Practice Address - Phone:931-363-3514
Practice Address - Fax:931-363-3595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CK2947OtherRAILROAD MEDICARE
TN3153524OtherBCBS TN
TN3153524OtherBCBS TN
CK2947OtherRAILROAD MEDICARE