ADVANCED MEDICAL GROUP (NPI# 1205167509) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1205167509 |
Entity Type | Organization |
Organization Name | ADVANCED MEDICAL GROUP |
Other Organization Name | FOOTHILLS PAIN MANAGEMENT |
Practice Address |
717 Watkins Rd Maryville TN 37801-4598 |
Mailing Address |
615 Leeper Pkwy Lenoir City TN 37772-6151 |
Practice Telephone | 8659807802 |
Practice Fax Number | 8659807804 |
Mailing Telephone | 8659868600 |
Mailing Fax Number | 8659860961 |
Enumeration Date | 2010-01-26 |
Last Update Date | 2010-01-26 |
Authorized Official Name | TERRY BRAGG (PRESIDENT) |
Authorized Official Telephone | 8659827802 |
Authorized Official Credential | DC |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
000011720 | TN | Physician Assistants & Advanced Practice Nursing Providers |
N | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
0000013567 | TN | Physician Assistants & Advanced Practice Nursing Providers |
Y | 208D00000X | General Practice | 0682 | TN | Allopathic & Osteopathic Physicians |
State | Issuer | Identifier | Type Code |
---|---|---|---|
TN | 1510839 | 05 |
Other Name | Type Code |
---|---|
Foothills Pain Management | Doing Business As Name - Organization |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1184232670 | Advanced Medical Group | Dermatology | 135 W Dimond Blvd Ste 104, Anchorage, AK 99515-1907 | 2020-07-21 |
1932741907 | Advanced Medical Group | General Practice | 3360 Prospect St, Hudsonville, MI 49426-1420 | 2019-10-11 |
1992723639 | Advanced Medical Group | Rehabilitation Practitioner | 155 Union St, Springfield, MA 01105-2010 | 2006-07-18 |
Entity Type | Entity Name | Entity Address |
---|---|---|
Colorado Business Entities | Advanced Medical Group Pikes Peak, LLC | 2728 Golden Current View, Colorado Springs, CO 80918 |
New York State Corporations | ADVANCED MEDICAL GROUP, P.C. | 2044 Ocean Avenue / Suite A-3, Brooklyn, Ny 11230 |
Street Address |
717 WATKINS RD |
City | MARYVILLE |
State | TN |
Zip Code | 37801-4598 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1912536582 | Andrea Waldrop | Pharmacist | 103 Foothills Mall Drive, Maryville, TN 37801 | 2020-04-06 |
1134664147 | Complete Vision Care Pllc | Optometrist | 2410 Us Hwy 411 S, Maryville, TN 37801 | 2016-12-29 |
1144634114 | James Muscari | Dentist | 824 W. Lamar Alexander Pkwy, Maryville, TN 37801 | 2014-06-17 |
1245465483 | Respiratory Home Care of Bristol, LLC | Durable Medical Equipment & Medical Supplies | 637 Morganton Square Dr, Maryville, TN 37801 | 2009-05-18 |
1063682383 | William R Pedersen | Optometrist | 730 West Lamar Alexander Pkwy, Maryville, TN 37801 | 2008-03-03 |
1124218573 | Liberty Assisted Living LLC | Assisted Living Facility | 312 Mcmaster Pl, Liberty Assisted Living LLC, Maryville, TN 37801 | 2007-07-31 |
1447467493 | Amanda G Clement | Nurse Practitioner | 1427 William Blount Drive, Maryville, TN 37801 | 2007-05-17 |
1396873758 | David T Cope | Audiologist | 821 Ross Drive, Maryville, TN 37801 | 2007-02-28 |
1649345406 | Adult & Family Dentistry, Inc. | Dentist | 1740 Big Springs Rd, Maryville, TN 37801 | 2006-11-21 |
1225109523 | Lincare Inc. | Durable Medical Equipment & Medical Supplies | 330 Southdowne Dr, Maryville, TN 37801 | 2006-11-10 |
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Taxonomy Code | 208D00000X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | General Practice |
Definition to come... |
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1609069822 | Kelli Louise Dubinsky | General Practice | 30227 Us Highway 136, Maryville, MO 64468-8353 | 2007-08-21 |
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1992342307 | Tennessee Spine Wellness & Medical Group LLC | General Practice | 470 Collier Dr, Sevierville, TN 37862-6931 | 2019-12-04 |
1952953648 | Balanced Medical Center Pllc | General Practice | 501 W Oakland Ave Ste 3, Johnson City, TN 37604-1667 | 2019-07-12 |
1326511676 | All About Health Medical, Pllc | General Practice | 2759 Highway 31 W Ste 2, White House, TN 37188-5246 | 2019-01-09 |
1912481870 | Kendall Elizabeth Bush | General Practice | 2416 21st Ave S Ste 101, Nashville, TN 37212-5310 | 2018-09-18 |
1891202941 | One To One Health | General Practice | 1413 Mccallie Ave, Chattanooga, TN 37404-2936 | 2018-01-10 |
1396269072 | Solutions Medical Centers Pllc | General Practice | Solutions Medical Centers, 851 W Elk Ave, Elizabethton, TN 37643 | 2017-08-03 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.