Provider Demographics
NPI:1730492737
Name:AMG CROCKETT, LLC
Entity Type:Organization
Organization Name:AMG CROCKETT, LLC
Other - Org Name:HOWARD SURGICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL DIR. PHYSICIAN SVCS
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:615-427-2239
Mailing Address - Street 1:1605 S LOCUST AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-4061
Mailing Address - Country:US
Mailing Address - Phone:931-766-7994
Mailing Address - Fax:931-766-7984
Practice Address - Street 1:1605 S LOCUST AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-4061
Practice Address - Country:US
Practice Address - Phone:931-766-7994
Practice Address - Fax:931-766-7984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-19
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty