Provider Demographics
NPI:1922436195
Name:AMG - SOUTHERN TENNESSEE, LLC
Entity Type:Organization
Organization Name:AMG - SOUTHERN TENNESSEE, LLC
Other - Org Name:SOUTHERN TENNESSEE NEUROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL DIRECTOR
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 1:66 SUNRISE PARK
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37398-2345
Mailing Address - Country:US
Mailing Address - Phone:931-967-0042
Mailing Address - Fax:931-967-0063
Practice Address - Street 1:66 SUNRISE PARK
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37398-2345
Practice Address - Country:US
Practice Address - Phone:931-967-0042
Practice Address - Fax:931-967-0063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-24
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1533091Medicaid
TN103G704291Medicare PIN