MEDICARE: EMG CLINICS OF TENNESSEE PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	204R00000X	Electrodiagnostic Medicine Physician
2	208100000X	Physical Medicine & Rehabilitation Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	DD3373	OTHER	TN	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	165324700	OTHER	TN	US DEPT OF LABOR
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962597492
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMG CLINICS OF TENNESSEE PLLC

Provider Business Mailing Address
First Line	:	3035 NORTH HIGHLAND AVE
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-3411
Country	:	US
Telephone Number	:	731-664-0899
Fax Number	:	731-664-0946

Provider Business Practice Location Address
First Line	:	3035 NORTH HIGHLAND AVE
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-3411
Country	:	US
Telephone Number	:	731-664-0899
Fax Number	:	731-664-0946

Authorized Official
Title or Position	:	CEO
Name	:	RONALD C BINGHAM
Credential	:	MD
Telephone Number	:	731-664-0899

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	10/28/2013

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