1407412604 NPI number — A&M ENTERPRISES LLC

Table of content: (NPI 1407412604)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407412604 NPI number — A&M ENTERPRISES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A&M ENTERPRISES 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:
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:
1407412604
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/13/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1333 NE ORENCO STATION PKWY # 661
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HILLSBORO
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97124-5409
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-648-3576
Provider Business Mailing Address Fax Number:
503-766-6473

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6125 NE CORNELL RD STE 390
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HILLSBORO
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97124-5417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-648-3576
Provider Business Practice Location Address Fax Number:
503-766-6473
Provider Enumeration Date:
05/13/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LOPEZ
Authorized Official First Name:
ARTURO
Authorized Official Middle Name:
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
619-770-6684

Provider Taxonomy Codes

  • Taxonomy code: 225700000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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