Provider Demographics
NPI:1922337559
Name:AMG-HILLSIDE LLC
Entity Type:Organization
Organization Name:AMG-HILLSIDE LLC
Other - Org Name:UROLOGY ASSOCIATES OF SOUTH CENTRAL TN
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 715
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:TN
Mailing Address - Zip Code:38478-0715
Mailing Address - Country:US
Mailing Address - Phone:931-363-9438
Mailing Address - Fax:931-363-9430
Practice Address - Street 1:600 E COLLEGE ST
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:TN
Practice Address - Zip Code:38478-4407
Practice Address - Country:US
Practice Address - Phone:931-363-1464
Practice Address - Fax:931-363-2368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-10
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN43985208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3153524OtherBCBS TN
CK2947OtherRR MEDICARE
TN3374856Medicare PIN