1053583559 NPI number — AMBIENT MEDICAL CARE, LLC

Table of content: MARK ALLEN MILLER MD (NPI 1699773150)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053583559 NPI number — AMBIENT MEDICAL CARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMBIENT MEDICAL CARE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053583559
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1827
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEAFORD
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19973-8827
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-629-3099
Provider Business Mailing Address Fax Number:
302-629-6059

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24459 SUSSEX HWY STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEAFORD
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19973-4425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-629-3099
Provider Business Practice Location Address Fax Number:
302-629-6059
Provider Enumeration Date:
03/25/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HENRY
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
ANTHONY
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
302-629-3099

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)